摘要
目的 探讨非酒精性脂肪性肝病(NAFLD)患者血清脂肪细胞因子前神经降压素(Pro-NT)和微小RNA-122(miRNA-122)水平变化及其诊断非酒精性脂肪性肝炎(NASH)的潜在价值.方法 2017 年1 月～2022 年6 月我院诊治的NAFLD患者159 例和同期入院体检的健康人90 例,行腹部超声检查,采用ELISA法检测血清Pro-NT水平,采用RT-PCR法检测血清miRNA-122.对NAFLD患者行肝活检检查,确定NASH诊断.应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估指标诊断的敏感度和特异度.结果 在 159 例NAFLD患者中,经肝活检检查诊断NASH患者49 例和单纯性脂肪肝110 例;NASH患者BMI为(28.4±1.2)kg/m2,显著大于NAFLD患者[(27.3±1.4)kg/m2,P＜0.05];NASH患者血清ALT、AST、空腹血糖(FBG)、胰岛素、HOMA-IR和尿酸水平分别为62(48,96)U/L、56(47,85)U/L、(5.9±0.6)mmol/L、10.2(8.8,13.4)μU/mL、2.6(1.8,3.4)和496(392,515)μmol/L,均显著高于NAFLD患者38(25,53)U/L、32(21,49)U/L、(5.3±0.6)mmol/L、9.0(7.2,12.6)μU/mL、2.2(1.3,2.7)和 446(351,495)μmol/L,P＜0.05];血清Pro-NT和miRNA-122 分别为167(148.4,186.9)pmol/L和 8.2(2.0,29.3),显著高于 NAFLD患者[分别为 82(53.0,100.4)pmol/L和2.2(1.4,10.6),P＜0.05];NAFLD患者上述指标又显著高于健康人(P＜0.05);分别以血清Pro-NT≥112 pmol/L和miRNA-122≥7.08 为截断点,结果 Pro-NT诊断NASH的AUC为0.824,灵敏度、特异度、阳性预测值和阴性预测值分别为80.0%、80.0%、84.9%和 82.3%,经 Delong 法检验,显著优于 miRNA-122 诊断(分别为 0.637、56.0%、70.0%、76.5%和56.8%,P＜0.05).结论 应用血清Pro-NT水平在NAFLD患者中初筛NASH可能有一定的临床价值,值得进一步研究.
Abstract
Objective The aim of this study was to explore the diagnostic performance of serum proneurotensin(Pro-NT),a adipose cytokine level and micro RNA(miRNA)load in patients with nonalcoholic steatohepatitis(NASH).Methods 159 patients with nonalcoholic fatty liver diseases(NAFLD)and 90 healthy persons were recruited in our hospital between January 2017 and June 2022,and the NAFLD was diagnosed by ultrasonography.Serum Pro-NT level was detected by ELISA,and serum miRNA load was assayed by RT-PCR.All patients with NAFLD received liver biopsies and the NASH was determined by histopathological examination.The area under the receiver operating characteristic curve(AUC)was applied to assess the diagnostic efficacy of serum parameters.Results Out of the 159 patients with NAFLD,the liver tissue examination found NASH in 49 cases(30.8%)and simple NAFLD in 110 cases(69.2%);the body mass index in patients with NASH was(28.4±1.2)kg/m2,much greater than[(27.3±1.4)kg/m2,P＜0.05]in patients with NAFLD;serum ALT,AST,fasting blood glucose,insulin,HOMA-IR and uric acid levels in patients with NASH were 62(48,96)U/L,56(47,85)U/L,(5.9±0.6)mmol/L,10.2(8.8,13.4)μU/mL,2.6(1.8,3.4)and 496(392,515)μmol/L,all significantly higher than 38(25,53)U/L,32(21,49)U/L,(5.3±0.6)mmol/L,9.0(7.2,12.6)μU/mL,2.2(1.3,2.7)and 446(351,495)μmol/L,respectively,P＜0.05]in patients with NAFLD;serum Pro-NT level and miRNA-122 load were 167(148.4,186.9)pmol/L and 8.2(2.0,29.3),much higher than[82(53.0,100.4)pmol/L and 2.2(1.4,10.6),respectively,P＜0.05]in patients with NAFLD;all the parameters in patients with NAFLD were much higher than in healthy persons(P＜0.05);the diagnostic performance by serum Pro-NT level(≥112 pmol/L as the cut-off-value)was much superior to serum miRNA-122(≥7.08 as the cut-off-value)by Delongin test in predicting the existence of NASH,with the AUC of 0.824,the sensitivity of 80.0%,the specificity of 80.0%,the positive predictive value of 84.9%and the negative predictive value of 82.3%,to 0.637,56.0%,70.0%,76.5%and 56.8%(P＜0.05)by serum miRNA-122.Conclusion Serum Pro-NT level might be acted as a non-invasive parameter for surveillance and screening of NASH in patients with NAFLD,and warrants further clinical investigation.
基金项目
四川省科技厅科研计划项目(2019YFS0038)
国家科技期刊平台
NSTL
维普
万方数据