非酒精性脂肪性肝病患者血清同型半胱氨酸、叶酸及维生素B_(12)水平变化的临床意义

Clinical significance of changes of serum homocysteine,folic acid,and vitamin B_(12) levels in patients with nonalcoholic fatty liver disease

目的探讨非酒精性脂肪性肝病(NAFLD)患者血清同型半胱氨酸(Hcy)、叶酸和维生素B_(12)水平变化的临床意义,为NAFLD的防治提供新思路。方法选择2017年5月至2018年12月在昆明医科大学第一附属医院体检中心接受无创肝纤维化诊断系统FibroTouch检查的199名体检者作为研究对象,根据FihroTouch检测结果的脂肪衰减参数(FAP)值分为健康对照组和NAFLD组,NAFLD组分为轻度、中度和重度肝脂肪变性组,根据肝脏硬度(LSM)值分为NAFLD非肝纤维化组和NAFLD合并肝纤维化组。检测各组的空腹血清Hcy、叶酸和维生素B_(12)水平,并对数据进行统计学分析。结果与健康对照组相比,NAFLD组的血清Hcy水平明显升高(P<0.05),血清维生素B_(12)水平明显降低(P<0.05),而两组的血清叶酸水平差异无统计学意义(P>0.05)。轻度、中度和重度肝脂肪变性组的血清Hcy、叶酸和维生素B_(12)水平差异均无统计学意义(P均>0.05),NAFLD非肝纤维化组与NAFLD合并肝纤维化组的血清Hcy、叶酸和维生素B_(12)水平差异也均无统计学意义(P均>0.05)。多因素logistic回归分析显示,血清Hcy和维生素B_(12)水平是NAFLD的危险因素(P<0.05)。Pearson直线相关性分析显示,血清Hcy水平与血清叶酸、维生素B_(12)水平呈直线负相关。结论高Hcy血症和维生素B_(12)缺乏是NAFLD的危险因素,在NAFLD发病机制中可能起着重要作用。血清Hcy、叶酸和维生素B_(12)不能作为NAFLD患者肝脂肪变性严重程度及是否合并肝纤维化的评价指标。

Objective This paper intends to explore the clinical significance of changes in serum homocysteine(Hcy),folic acid,and vitamin B_(12) levels in patients with nonalcoholic fatty liver disease(NAFLD),and provide new ideas for the prevention and treatment of NAFLD.Methods A total of 199 physical examiners who underwent noninvasive liver fibrosis diagnosis system FibroTouch examination in the Physical Examination Center of the First Affiliated Hospital of Kunming Medical University from May 2017 to December 2018 were selected and assigned to the healthy control group and the NAFLD group based on the fat attenuation parameter(FAP)value of FihroTouch test results.The NAFLD group was divided into the mild,the moderate,and the severe hepatic steatosis group,which were further divided into the NAFLD nonhepatic fibrosis group and the NAFLD combining hepatic fibrosis group according to the liver stiffness(LSM)value.The fasting serum Hcy,folic acid,and vitamin B_(12) levels in each group were detected,and the data were statistically analyzed.Results Compared with the healthy control group,the serum Hcy level in the NAFLD group is significantly increased(P<0.05),and the serum vitamin B_(12) level is significantly decreased(P<0.05),while there is no significant difference in the serum folic acid level between the two groups(P>0.05).There is no significant difference in serum Hcy,folic acid,and vitamin B_(12) levels between the mild,the moderate,and the severe hepatic steatosis group(P>0.05).There are no significant differences in serum Hcy,folic acid,and vitamin B_(12) levels between the NAFLD nonhepatic fibrosis group and the NAFLD combining hepatic fibrosis group(P>0.05).Multivariate logistic regression analysis shows that serum Hcy and vitamin B_(12) levels are risk factors for NAFLD(P<0.05).Pearson linear correlation analysis shows that serum Hcy levels are negatively correlated with serum folic acid and vitamin B_(12) levels.Conclusions HyperHcy and vitamin B_(12) deficiency are risk factors for NAFLD and may play an important role in the pathogenesis of NAFLD.Serum Hcy,folic acid,and vitamin B_(12) cannot be used as evaluation indicators for the severity of hepatic steatosis and liver fibrosis in patients with NAFLD.