血清铁蛋白对非酒精性脂肪肝患者早期肝纤维化的诊断价值

Clinical value of serum ferritin in diagnosis for hepatic fibrosis in patients with nonalcoholic fatty liver disease

目的研究血清铁蛋白(SF)对非酒精性脂肪肝(NAFLD)患者早期肝纤维化的诊断价值。方法随机选取104例NAFLD患者和60例健康人进行血清学、肝脏B超和SF检查。NAFLD患者行肝脏活组织检查。分析并评价SF对NAFLD患者早期肝纤维化的诊断价值。结果 NAFLD患者的丙氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶(GGT)、总胆固醇(TC)、三酰甘油(TG)、透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原氨基端肽(PⅢNP)、Ⅳ型胶原(CⅣ)、SF均高于健康对照组,差异有统计学意义(P<0.05)。0期肝纤维化患者的HA、CⅣ和SF小于早期患者,差异有统计学意义(P<0.05)。在早期患者中,相关性分析显示SF水平与HA、CⅣ呈正相关(rHA=0.44,rCⅣ=0.53,P<0.05)。ROC曲线发现SF对早期肝纤维化患者的诊断曲线下面积为0.688(P=0.005),当SF为93μg/L时,诊断的灵敏度为73%,特异性为67%。结论血清SF的升高能够反映NAFLD患者早期肝纤维化的变化,有望成为NAFLD早期肝纤维化的血清学辅助诊断指标。

Objective To evaluate the clinical value of serum ferritin（SF）in diagnosis for hepatic fibrosis in patients with nonalcoholic fatty liver disease（NAFLD）.Methods One hundred and four NAFLD patients and sixty healthy controls were enrolled in this study.Serum routine test,hepatic ultrasonography and serum ferritin for all participants were assessed and liver biopsy were performed for NAFLD patients.Results The levels of alanine aminotransferase（ALT）,gamma glutamine transferase（GGT）,total cholesterol（TC）,triacylglycerol（TG）,hyaluronic acid（HA）,laminin（LN）,ProcollagenⅢ N-terminal peptide（PⅢNP）,Collagen TypeⅣ（CⅣ）and SF in NAFLD patients were significantly higher than those of healthy controls（P〈0.05）.The levels of HA,CⅣ and SF in fibrosis stage 0 patients were lower than the early stage patients（P〈0.05）.SF was positive correlated with HA andCⅣ by Spearman analysis（rHA=0.44,rCⅣ=0.53,P〈0.05）.The area under curve（AUC）of receiver operating characteristic（ROC）of SF was 0.688.When the SF level was 93μg/L,the sensitivity and specificity of SF were 73% and 67% respectively.Conclusion Serum levels of ferritin is positively correlated with the severity of liver fibrosis,which would be a promising biomarker for early fibrosis patients with NAFLD.