血清视黄醇结合蛋白4与绝经后女性非酒精性脂肪性肝病的相关性分析

Serum Retinol-binding Protein 4 and Non-alcoholic Fatty Liver Disease in Postmenopausal Women

背景绝经后女性是非酒精性脂肪性肝病(NAFLD)的危险人群,罹患该病可能导致致死性心血管疾病及其他代谢异常。但NAFLD好发于这一特定生理阶段的机制尚未完全明确。目的检测绝经后NAFLD女性血清视黄醇结合蛋白4(RBP4)水平,探讨绝经后女性血清RBP4水平与NAFLD的关系。方法选取2017年5—8月在浙江大学医学院附属杭州市第一人民医院体检中心接受健康体检的37～66岁女性181例。根据是否处于绝经状态和是否符合NAFLD诊断标准分为4组,即绝经前对照组(n=42)、绝经前NAFLD组(n=42)、绝经后对照组(n=36)和绝经后NAFLD组(n=61)。比较各组间血清RBP4水平,应用二分类Logistic回归分析绝经后女性血清RBP4水平与NAFLD的关系,采用受试者工作特征曲线(ROC曲线)及曲线下面积(AUC)分析血清RBP4的诊断价值。结果绝经后NAFLD组女性血清RBP4水平高于绝经前对照组和绝经后对照组,差异有统计学意义(P<0.05)。校正混杂因素后Logistic回归分析显示,血清RBP4水平升高[OR=1.155,95%CI(1.059,1.260),P<0.05]是绝经后女性NAFLD发生的危险因素。血清RBP4水平预测绝经后NAFLD的ROC曲线的AUC为0.841,95%CI为(0.757,0.924),最佳截断值为25.1 mg/L,灵敏度为0.78,特异度为0.79(P<0.001)。结论血清RBP4水平升高与绝经后女性NAFLD发生相关,对绝经后NAFLD的发生具有较好的辅助诊断价值。

Background Postmenopausal women are more prone to non-alcoholic fatty liver disease(NAFLD),a disease possibly leads to fatal cardiovascular disease and other metabolic disorders.However,the underlying pathogenesis of NAFLD after menopause is still unclear.Objective To investigate the association of serum retinol-binding protein 4(RBP4)with NAFLD in postmenopausal women.Methods A total of 181 women aged between 37 and 66 years old were recruited from the Health Checkup Department of Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine from May to August 2017.They were divided into four groups according to the menopausal status and NAFLD diagnostic results,including premenopausal control group(n=42),premenopausal NAFLD group(n=42),postmenopausal control group(n=36)and postmenopausal NAFLD group(n=61).Serum RBP4 was compared between the groups.Binary Logistic regression analysis was performed to explore the association between serum RBP4 and NAFLD.The diagnostic value of serum RBP4 for NAFLD was investigated by ROC curve and the area under the ROC curve(AUC)analyses.Results The average serum RBP4 level in postmenopausal NAFLD group was significantly higher compared to premenopausal control group and postmenopausal control group(P<0.05).After adjusting for confounding factors,Logistic regression analysis showed that elevated serum RBP4〔OR=1.155,95%CI(1.059,1.260),P<0.05〕was an independent risk factor for NAFLD in postmenopausal period.The AUC of serum RBP4 for predicting NAFLD in postmenopausal women was 0.841〔95%CI(0.757,0.924)〕,the optimal cut-off value was 25.1 mg/L,with a sensitivity of 0.78 and a specificity of 0.79(P<0.001).Conclusion Elevated serum RBP4 level is positively associated with NAFLD in postmenopausal women.So serum RBP4 level has a good auxiliary diagnostic value for NAFLD in such a population.