血浆肾素活性对非酒精性脂肪肝进展的诊断价值

The significance of plasma renin activity on the diagnosis of progress of nonalcoholic fatty liver disease

目的探讨血浆肾素活性(PRA)对非酒精性脂肪肝病(NAFLD)进展的诊断价值。方法选择NAFLD患者159例,根据肝脏CT结果(肝/脾CT值比)的严重程度,分为轻度组119例和中重度组40例;选择与NAFLD有相似临床表现但肝脏CT无异常的非NAFLD患者191例作为对照组。检测患者肝功能、血脂及PRA,分析PRA与NAFLD严重程度及各生化指标的相关性;分别作PRA和ALT诊断NAFLD进展的ROC曲线,比较两者对NAFLD进展的诊断效能。结果 (1)轻度组和中重度组的PRA、ALT、GGT、TG、TC、LDL-C均较对照组升高(P<0.05),HDL-C则降低(P=0.000);中重度组的ALT、GGT、PRA较轻度组升高(P=0.021、0.012、0.006),HDL-C较轻度组降低(P=0.042)。(2)PRA与ALT、GGT、TG呈正相关(r值分别为0.144、0.356、0.172,均P<0.05),与肝/脾CT值比、HDL-C呈负相关(r值分别为-0.238,-0.163,均P<0.05)。(3)ALT>40 U/L和PRA>19 pg/mL是NAFLD进展的独立危险因素(OR=6.080、7.563,P=0.005、0.009)。(4)ROC曲线显示,PRA的曲线下面积为0.676,cut-off值为26.86 pg/mL,以PRA大于此临界值诊断NAFLD进展的灵敏度为94.1%,其曲线下面积及灵敏度均高于ALT。结论 PRA是比ALT更灵敏的一项评价NAFLD发生进展的指标。

Objective To investigate plasma renin activity （ PRA） in patients with nonalcoholic fatty liver dis-ease （ NAFLD） , and to explore the correlation between PRA and serum biochemical parameters .Methods A total of 350 patients were divided into NAFLD group （159 cases） and control group （191 cases）.NAFLD patients, according to abdominal CT （ liver/spleen CT value ratio ） , were further divided into two subgroups：mild group and moderate -severe group.All patients′PRA was measured, as well as the indexes of transaminase , blood lipids.The association between PRA and serum biochemical parameters were analyzed .The receiver operator characteristic （ ROC） analyses for PRA and ALT were performed and cut -off value was determined .Results Compared with the normal control group , the levels of PRA, ALT, GGT, TG, TC and LDL-C were significantly higher in NAFLD group （P〈0.05）, whereas HDL-C was significantly lower （P=0.000）.The levels of ALT, GGT and PRA of moderate-severe group were significantly highest （P=0.021, 0.012, 0.006）, while HDL-C the lowest （P=0.042）.PRA was significantly positively correlated with ALT, GGT and TG （r=0.144, 0.356, 0.172, all P＆lt;0.05）, but negatively correlated with liver/spleen CT value ratio and HDL-C （r=-0.238, -0.163, both P〈0.05）.ALT〉40 U/L and PRA〉19 pg/mL were key risk factors in the progress of NAFLD （OR=6.080, 7.563;P=0.005, 0.009）.AUC of PRA was 0.676 with 26.86 pg/mL as cut-off value, with sensitivity of 94.1%;which was higher than those of ALT .Conclusion PRA is a more sensitive index for auxiliary assessment of the severity and prognosis of NAFLD .