非酒精性脂肪肝病患者血清PTX3水平与胰岛素抵抗以及氧化应激相关分析

The relationship between serum PTX3 and oxidative stress, insulin resistance in patients with non-alcohol fatty liver disease

目的：检测非酒精性脂肪肝患者血清脂肪因子PTX3水平，并探讨PTX3与胰岛素抵抗以及氧化应激之间的相关性。方法用ELISA方法检测合并胰岛素抵抗的非酒精性脂肪肝患者41例（A组），单纯性非酒精性脂肪肝患者93例（B组）以及140例健康对照组（C组）血清PTX3脂肪因子水平，同时收集研究对象空腹胰岛素和糖脂代谢参数等资料。探讨PTX3与胰岛素抵抗之间的相关性。Logistic回归模型分析非酒精性脂肪肝合并胰岛素抵抗的危险因素；绘制ROC曲线，获得检测时脂肪因子PTX3对非酒精性脂肪肝合并胰岛素抵抗诊断效能。结果非酒精性脂肪肝组患者血清PTX3脂肪因子浓度均显著高于健康对照组[（3.2±1.2）ng/ml vs.（2.0±0.6）ng/ml，P =0.000]；合并胰岛素抵抗的非酒精性脂肪肝组PTX3脂肪因子浓度均显著高于单纯性非酒精性脂肪肝[（4.5±1.2）ng/ml vs.（2.5±0.6 ng/ml）， P =0.001]。相关分析表明PTX3脂肪因子与HOMA-IR（r =0.236，P =0.001）,空腹血糖（r =0.312，P=0.012），MDA（r =0.004，P =0.001）呈正相关，但与GSH（r =-303，P =0.001）呈负相关。Logistic回归分析表明PTX3脂肪因子是非酒精性脂肪肝胰岛素抵抗的的独立因素（OR 1.45，95% CI：1.131.912，P =0.041），血清PTX3脂肪因子鉴别非酒精性脂肪肝是否合并胰岛素抵抗ROC曲线下面积为0.712，诊断非酒精性脂肪肝是否合并胰岛素抵抗最佳截点为3.86 ng/ml（敏感度：51.9%，特异度：94.5%，P =0.012）,进一步以PTX3脂肪因子截点为参照，在非酒精性脂肪肝患者中当血清PTX3脂肪因子高于3.86 ng/ml时合并胰岛素抵抗的风险增加（OR =3.6，95% CI：3.1913.36，P=0.000）。多重线性回归分析提示GSH、超敏C反应蛋白、胰岛素抵抗指数为影响PTX3脂肪因子水平的独立相关因素。结论血清PTX3脂肪因子与胰岛素抵抗以及氧化应激密切相关，有助于非酒精性脂肪肝病情发展的评估。

Objective To detect the serum levels of PTX3 in patients with non-alcohol fatty liver disease（NAFLD） and to analyze the relationship between serum PTX3 and oxidative stress, insulin resistance（IR） in non-alcohol fatty liver disease.Methods Enzyme linked immunosorbent assay （ELISA） was applied to detect the serum PTX3 in 41 NAFLD patients complicated with IR, 93 NAFLD patients without IR and 140 healthy controls. Besides, metabolic parameters clinical data was collected. Correlation analysis was performed to explore the relationship between serum PTX3 and oxidative stress, insulin and IR. The multivariate logistic regression analysis was applied to analyze the risks factors for NAFLD patients complicated with IR. Receiver operating characteristic （ROC） analyses were performed to explore the diagnosis value of PTX3 in IR of NAFLD patients.Results The average PTX3 in serum concentration in non-alcohol fatty liver disease patients was signiifcantly higher than that in healthy controls [（3.2 ± 1.2） ng/ml vs. （2.5 ± 0.6） ng/ml,P = 0.000]. The concentration in NAFLD patients complicated with IR was also higher than＆amp;nbsp;that in NAFLD patients without IR[（4.5 ± 1.2） ng/ml vs. （2.0 ± 0.6） ng/ml,P = 0.001]. Correlation analysis indicated that PTX3 was positively correlated to HOMA-IR （r = 0.236, P = 0.001）, fasting plasma glucose （r = 0.312,P = 0.012）, MDA （r = 0.004,P = 0.001）, and negatively correlated to GSH （r = -303,P = 0.001）. Multiple logistics regression analysis showed that PTX3 was an independent protective factor for non-alcohol fatty liver disease with IR （OR 1.45, 95% CI ：1.13-1.912,P = 0. 041）. The area under the ROC curves for PTX3 to distinguish IR from NAFLD was 0.712 for PTX3, with a cut-off value of 3.86 ng/ml （sensitivity：51.9%; speciifcity： 94.5%;P = 0.012）. In addition, individuals in non-alcohol fatty liver disease patients with higher 3.86 ng/ml PTX3 were associated with increased risk of IR （OR = 3.67, 95%CI： 3.19-13.36,P = 0.000）. Multiple stepwise linear regression analysis showed that GSH, hs-CRP and HOMA-IR were independent risk factors for PTX3.ConclusionsPTX3 is closely related to oxidative stress and insulin resistance in NAFLD. It is useful for disease surveillance by monitoring PTX3.