细胞角蛋白18片段和炎症相关因子在非酒精性脂肪性肝病不同代谢组分的表达水平及意义

Expression of Cytokeratin 18 fragment and inflammation related factors in nonalcoholic fatty liver disease with different metabolic syndrome compositions

目的探讨细胞角蛋白18片段、炎症相关因子与代谢综合征(metabolic syndrome,MS)组分多少在非酒精性脂肪性肝病患者(non-alcoholic fatty liver disease,NAFLD)表达水平的差异及其临床意义。方法纳入非酒精性脂肪性肝病患者85例。根据含代谢危险因素1个、2个及3个或以上分为MS1、MS2和MS3 3组。记录入选患者病史和人体学资料,检测生化常规、空腹和餐后2 h血糖和胰岛素、血脂、超敏C反应蛋白、糖化血红蛋白;采用酶联免疫吸附法(ELISA)检测血清中细胞角蛋白18片段、炎症相关因子TNF-α、IL-6表达水平。速率散射比浊法检测血清超敏C-反应蛋白表达水平。结果血清细胞角蛋白18(M30)在MS3组表达与MS1、MS2组比较差异有统计学意义(F=3.77,P<0.05)。IL-6在MS3组中表达水平与MS1、MS2组比较差异有统计学意义(F=6.39,P<0.05)。且ALT、GGT在MS3组中表达水平与MS1组比较差异有统计学意义(F=14.02,P<0.05;F=6.18,P<0.05)。结论非酒精性脂肪性肝病中当代谢危险因素数量达到3个或以上时,反映肝脏凋亡及炎症的细胞角蛋白18片段和炎症相关因子的表达水平较3个以下代谢危险因素者增高,提示代谢危险因素的增多可能是NAFLD病人肝脏凋亡和炎症的危险因素。

Objective To investigate the expression and clinical significance of Cytokeratin 18（CK-18） fragment and inflammation related factors in nonalcoholic fatty liver disease（NAFLD） with different metabolic syndrome（MS） compositions.Methods Eighty-five cases of NAFLD patients were enrolled.All patients were divided into three groups according to the amount of the compositions of MS： MS1,MS2 and MS3.Medical history,physical examination were recorded.The conventional biochemical tests,fasting blood sugar and insulin,postprandial 2 hour sugar,blood lipid,Hs-CRP and glycosylated hemoglobin were performed respectively,serum expression of CK-18 and inflammation related factors TNF-α,IL-6 were measured by ELISA,Hs-CRP was measured by the rate of scattering method.Results there was a significant difference of serum expression of CK-18 fragment in MS3 group,compared with MS1,MS2 groups（P0.05）,and the levels of serum IL-6,plasma ALT and GGT in the MS3 group were significantly higher than those in the MS2 and MS1 groups（F=6.39,P0.05;F=14.02,P0.05;F=6.18,P0.05）.Conclusion When the compositions of MS are more than or equate to three,the inflammatory reaction and apoptosis of hepatocyte may be more obvious than that less than three compositions.