血清学指标在非酒精性脂肪性肝病诊断中的意义

Significance of serological markers in diagnosis of nonalcoholic fatty liver disease

近年来,脂肪性肝病发病率呈明显上升趋势,肝脏活组织检查是诊断脂肪肝的金标准,但有其不可避免的缺点。目前尚缺乏一种方便、价廉、准确、适用于临床的无创诊断方法。主要回顾了多项血清学指标在非酒精性脂肪性肝病(NAFLD)诊断中的意义,认为血清学指标中肝酶、AST与ALT比值、血清铁蛋白、血清硒、尿酸、高空腹胰岛素浓度、视黄醇结合蛋白4、细胞角蛋白18、PNPLA3基因、TM6SF2基因在NAFLD的诊断中有较大的价值,而IL-28B对NAFLD的诊断价值存在较大争议,尚需更多临床试验证实。相信在不久的将来,多项血清指标组合会成为较准确,且适用于临床的早期诊断NAFLD、肝脂肪变性程度及肝纤维化程度的无创方法。

In recent years, the incidence rate of fatty liver tends to increase markedly, and liver biopsy is the gold standard for the diagnosis of fatty liver, but it has some inevitable shortcomings. At present, there lacks a convenient, cheap, and accurate noninvasive diagnostic method for clinical practice. This article reviews the significance of various serological markers in the diagnosis of nonalcoholic fatty liver dis- ease （NAFLD） and points out that liver enzyme, aspartate aminotransferase/alanine aminotransferase ratio, serum ferritin, serum selenium, uric acid, high fasting insulin level, retinol - binding protein - 4, cytokeratin - 18, PNPLA3 gene, and TM6SF2 gene have great signifi- cance in the diagnosis of NAFLD. There are still controversies over the value of interleukin -28B in the diagnosis of NAFLD, and more clin- ical trials are needed. We believe that in the near future, a combination of various serum markers may become an accurate noninvasive meth- od for the diagnosis of NAFLD and the assessment of the degree of liver fatty degeneration and fibrosis.