非酒精性脂肪肝患者血清脂多糖结合蛋白表达水平及临床意义

Expression level and clinical significance of serum lipopolysaccharide binding protein in patients with nonalcoholic fatty liver

目的探讨非酒精性脂肪性肝病(NAFLD)患者血清脂多糖结合蛋白(LBP)表达情况及临床意义。方法纳入苏州大学附属第一医院2018年1—12月收治的65例NAFLD患者(NAFLD组)和65例性别、年龄与之相匹配的非NAFLD患者(对照组)进行研究,比较2组人口学资料[性别、年龄、体质量指数(BMI)、腰臀比(WHR)]及血清LBP水平、肝酶指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(GGT)]水平、糖代谢和胰岛素功能相关指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、空腹C肽、稳态模型胰岛素抵抗指数(HOMA-IR)=FPG×FINS/22.5]水平、脂代谢相关指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、极低密度脂蛋白胆固醇(VLDL-C)]水平、脂肪细胞因子[瘦素、抵抗素、脂联素、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平,分析血清LBP水平与NAFLD的相关性,采用双变量相关性分析法(Pearson相关系数或Spearman相关系数)及多重逐步线性回归法分析血清LBP水平与NAFLD患者人口学资料、血清学指标的相关性。结果NAFLD组血清LBP水平明显高于对照组[(48.09±23.62)μg/mL和(31.51±19.14)μg/mL,P<0.001],且血清LBP水平与NAFLD患病呈正相关[校正后OR=1.034,95%CI(1.015,1.053),P<0.001];血清LBP预测NAFLD的受试者工作特征曲线下面积为0.736[95%CI(0.649,0.823)]。血清LBP水平与BMI(r=0.245,P=0.005)、WHR(r=0.282,P=0.001)及血清GGT(r=0.253,P=0.004)、HDL-C(r=-0.188,P=0.032)、FPG(r=0.412,P<0.001)、HbA1c(r=0.329,P<0.001)、HOMA-IR(r=0.344,P<0.001)、空腹C肽(r=0.276,P=0.002)、抵抗素(r=0.270,P=0.048)、IL-6(r=0.379,P=0.005)、TNF-α(r=0.368,P=0.006)均有相关性。结论血清LBP可作为诊断NAFLD的潜在生物标志物,其与机体免疫、炎症反应和胰岛素敏感性密切相关。

Objective It is to investigate the expression and clinical significance of serum lipopolysaccharide binding protein(LBP)in patients with non-alcoholic fatty liver disease(NAFLD).Methods A total of 65 patients with NAFLD(NAFLD group)and 65 patients with non-NAFLD matching the gender and age(control group)admitted to the First Affiliated Hospital of Suzhou University from January to December 2018 were included in the study to compare their demographics information[sex,age,body mass index(BMI),waist-to-hip ratio(WHR)]and serum LBP levels,liver enzyme indexes[glutamine transaminase(ALT),aspartate transaminase(AST),γ-glutamyl transpeptidase(GGT)],glucose metabolism and insulin function related indicators[fasting blood glucose(FPG),glycated hemoglobin(HbA1c),fasting insulin(FINS),fasting C peptide,homeostasis model assessment of insulin resistance(HOMA-IR)=FPG×FINS/22.5],indicators related to lipid metabolism[total cholesterol(TC),triacylglycerol(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),very low density fat Protein cholesterol(VLDL-C)],adipocytokines[leptin,resistin,adiponectin,interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)],the correlation between serum LBP level and NAFLD was analyzed,bivariate correlation analysis(Pearson correlation coefficient or Spearman correlation coefficient)and multiple stepwise linear regression analysis was used to analyze the correlation serum LBP level with the population demographics and serological indicators of NAFLD patients.Results The serum LBP level in the NAFLD group was significantly higher than that in the control group[(48.09±23.62)μg/mL and(31.51±19.14)μg/mL,P<0.001],and the serum LBP level was positively correlated with the prevalence of NAFLD[adjusted OR=1.034,95%CI(1.015,1.053),P<0.001];the area of receiver operating characteristic curve of serum LBP for predicting NAFLD was 0.736[95%CI(0.649,0.823)].Serum LBP level was related with BMI(r=0.245,P=0.005),WHR(r=0.282,P=0.001)and serum GGT(r=0.253,P=0.004),HDL-C(r=-0.188,P=0.032),FPG(r=0.412,P<0.001),HbA1c(r=0.329,P<0.001),HOMA-IR(r=0.344,P<0.001),fasting C peptide(r=0.276,P=0.002),resistin(r=0.270,P=0.048),IL-6(r=0.379,P=0.005),and TNF-α(r=0.368,P=0.006).Conclusion Serum LBP can be used as a potential biomarker for the diagnosis of NAFLD,which is closely related to body immunity,inflammation and insulin sensitivity.