血清CK18-M65、M30与非酒精性脂肪肝病的相关性

Association of serum CK18-M65 and -M30 with nonalcoholic fatty liver disease

目的:分析血清CK18-M30、M65与非酒精脂肪肝病(non-alcoholic fatty liver disease,NAFLD)的相关性.探讨其在NAFLD形成过程中的可能作用机制,为预防NAFLD的向严重肝病发展提供临床依据.方法:选取2011-06/2013-01在新疆医科大学第一附属医院选择非酒精性脂肪肝患者309例,选择健康对照人群290例;平均年龄44.09岁±9.99岁;对所有研究对象进行问卷调查、体格检查、腹部超声检查以及血液生化指标;同时采用酶联免疫吸附法检测血清中细胞角蛋白18-M30和细胞角蛋白18-M65浓度.结果:维吾尔族、汉族人群N A F L D组CK18-M30水平分别为249.03 ng/L±133.58n g/L、244.06 n g/L±73.76 n g/L,对照组C K18-M30水平分别为142.30 n g/L±31.89ng/L、143.16 ng/L±93.31ng/L,病例组高于对照组且差异具有统计学意义(P<0.05);维吾尔族、汉族人群NAFLD组CK18-M65水平分别为154.69 ng/L±138.07 ng/L、222.08ng/L±170.52 ng/L,对照组CK18-M65水平分别为160.70 ng/L±134.19 ng/L、239.52 ng/L±196.16 ng/L,NAFLD与对照组CK18-M65水平差异无统计学意义.在校正年龄、体质量指数(body mass index,BMI)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、中性粒细胞计数(neutrophil count,NEUT)、淋巴细胞计数(lymphocyte count,LY)、血红蛋白浓度、空腹血糖(fasting plasma glucose,FPG)、血清甘油三酯(serum triglyceride,TG)、血清胆固醇(total cholesterol,TC)、高密度脂蛋白(high-density lipoprotein,HDL)、低密度脂蛋白(low-density lipoprotein,LDL)等后,NAFLD组CK18-M30水平高于对照组,而NAFLD组与对照组间CK18-M65水平差异无统计学意义.多因素Logistic回归分析结果提示在校正了性别、年龄、BMI、SBP、DBP、TG、TC、HDL、LDL等因素影响的情况下,血清CK18-M30水平是患NAFLD危险因素,OR值为1.300(P<0.01).结论:CK18-M30水平升高与NAFLD密切相关,且是NAFLD独立危险因素,而CK18-M65水平与NAFLD无相关性.

AIM： To analyze the association of serum CK18-M65 and -M30 with non-alcoholic fatty liver disease （NAFLD） and to discuss the pos- sible mechanisms responsible for the formation of NAFLD. METHODS： Three hundred and nine patients with NAFLD treated from June 2011 to January 2013 at the First Affiliated Hospital of Xinjiang Medical University were included in this study.Two hundred and ninety healthy people served as normal controls. The average age of all sub- jects was 44.09 years ± 9.99 years. Questionnaire surveys, physical examination, abdominal ul- trasound examination and blood biochemical examination were completed in all subjects. The levels of serum 18-M65 and -M30 were deter- mined using ELISA. RESULTS： Serum levels of CK18-M30 were significantly higher in the NAFLD group than in the control group in both Uyghur and Han Chinese populations （249.03 ng/L ± 133.58 ng/ L vs 142.30 ng/L ±31.89 ng/L, 244.06 ng/L ± 73.76 ng/L vs 143.16 ng/L ± 93.31 ng/L, both P 〈 0.05）. There were no significant differences in serum levels of CK18-M65 between the NAFLD group and control group in both Uyghur and Han Chinese populations （154.69 ng/L ± 138.07 ng/L vs 160.70 ng/L ± 134.19 ng/L, 222.08 ng/L ± 170.52 ng/L vs 239.52 ng/L ± 196.16 ng/L, both P 〉 0.05）. After adjusting for age, body mass index （BMI）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, neu- trophil count, lymphocyte count, hemoglobin concentration, fasting plasma glucose, serum triglyceride （TG）, total cholesterol （TC）, high- density lipoprotein （HDL）, and low-density lipoprotein （LDL）, serum levels of CK18-M30 were still significantly higher in the NAFLD group than in the control group, although no significant difference was noted in serum lev- els of CK18-M65. Logistic regression analysis showed that serum CK18-M30 level was a risk factor for NAFLD （OR = 1.300, P 〈 0.01）, after adjusting for gender, age, BMI, SBP, DBP, TG, TC, HDL, and LDL. CONCLUSION： Elevation of serum CK18-M30 levels is closely associated with NAFLD, and is an independent risk factor for NAFLD. Serum levels of CK18-M65 are unrelated to NAFLD.