Abstract: Objective The aim of this study was to explore the implications of serum amyloid A (SAA), plasma heme oxygenase-1 (HO-1) and bone morphogenetic protein 9 (BMP-9) level changes in patients with nonalcoholic fatty liver diseases (NAFLD). Methods 87 patients with NAFLD [simple fatty liver (SFL, n=28), nonalcoholic steatohepatitis (NASH, n=48) and liver cirrhosis (n=11)] and 56 healthy individuals were enrolled in our hospital between July 2018 and March 2022, and all patients with NAFLD underwent liver biopsies. The patients with NASH were divided histopathologically into early (n=10) and liver fibrosis stage (n=38). Serum SAA level was assayed by chemiluminescence immunoassay, and plasma HO-1 and BMP-9 levels were detected by double antibody sandwich ELISA. Results Serum SAA and plasma HO-1 levels in patients with NAFLD were (8.2±1.5)mg/L and (14.9±2.3)ng/ml, both significantly higher than [(3.3±0.6) mg/L and (10.1±2.1)ng/ml, respectively, P<0.05], while plasma BMP-9 level was (95.1±6.1)pg/ml, significantly lower than [(153.7±10.8)pg/ml, P<0.05] in healthy persons; serum SAA and plasma HO-1 levels in patients with NAFLD-related liver cirrhosis were (9.9±1.5)mg/L and (17.2±2.6)ng/ml, both much higher than [(8.3±1.1)mg/L and (15.2±2.4)ng/ml, respectively, P<0.05] in patients with NASH or [(7.5±0.9)mg/L and (13.7±2.1)ng/ml, respectively, P<0.05] in patients with SFL, while plasma BMP-9 level was (81.8±6.9)pg/ml, much lower than [(93.6±7.3)pg/ml, P<0.05] in patients with NASH or [(101.7±5.1)pg/ml, P<0.05] in patients with SFL; serum SAA and plasma HO-1 levels in patients with NASH-related fibrosis were (9.0±1.8)mg/L and (16.4±2.5)ng/ml, significantly higher than [(6.6±1.9)mg/L and (12.0±2.8)ng/ml, respectively, P<0.05], while plasma BMP-9 level was (87.5±4.7)pg/ml, significantly lower than [(98.8±5.1)pg/ml, P<0.05] in patients with early fibrosis. Conclusion The changes of serum SAA, and plasma HO-1 and BMP-9 levels in patients with NAFLD might be related to hepatic steatosis and fibrosis, which needs further investigation.

Key words: Nonalcoholic fatty liver diseases, Amyloid A, Heme oxygenase-1, Bone morphogenetic protein 9