慢性丙型肝炎合并非酒精性脂肪性肝病患者血清RBP4和SREBP-1c水平变化分析

Changes of serum RBP4 and SREBP-1c levels in patients with chronic hepatitis C and non-alcoholic fatty liver diseases

目的 探讨慢性丙型肝炎(CHC)合并非酒精性脂肪性肝病(NAFLD)患者血清视黄醇结合蛋白4(RBP4)和固醇调节元件结合蛋白-1c(SREBP-1c)水平变化及其临床意义。方法 2019年2月~2022年2月我院收治的CHC患者94例,接受肝穿刺活检和重组人干扰素-α2a联合利巴韦林治疗24周。使用全自动生化分析仪检测血生化指标,计算稳态模型胰岛素抵抗指数(HOMA-IR),采用ELISA法检测血清RBP4和SREBP-1c水平。结果 经组织病理学检查发现,在94例CHC患者中,合并NAFLD患者50例(53.2%),其中肝轻度脂肪变22例(44.0%)和中重度脂肪变28例(56.0%);CHC合并中重度脂肪变患者血清AST、ALT、ALP和GGT水平分别为(62.2±12.8)U/L、(87.2±11.5)U/L、(99.0±14.4)U/L和(69.4±10.3)U/L,显著高于CHC合并轻度脂肪变患者【分别为(53.6±10.1)U/L、(75.7±12.5)U/L、(83.8±12.7)U/L和(58.5±7.7)U/L,P<0.05】或CHC患者【分别为(51.7±8.5)U/L、(73.5±13.8)U/L、(81.6±10.9)U/L和(56.2±8.1)U/L,P<0.05】;CHC合并中重度脂肪变患者血清RBP4和SREBP-1c水平分别为(55.9±8.2)mg/L和(40.1±7.4)μg/L,显著高于合并轻度脂肪变患者【分别为(36.7±5.8)mg/L和(29.3±5.1)μg/L,P<0.05】或CHC患者【分别为(28.4±6.3)mg/L和(21.8±5.5)μg/L,P<0.05】;中重度脂肪变患者血清HbA1c和HOMA-IR水平分别为(5.7±0.5)%和(3.2±0.5),显著高于CHC合并轻度脂肪变患者【分别为(5.3±0.5)%和(2.5±0.4),P<0.05】或CHC患者【分别为(5.1±0.3)%和(1.9±0.3),P<0.05】;41例治疗应答组血清RBP4和SREBP-1c水平分别为(25.7±6.0)mg/L和(20.6±5.0)μg/L,显著低于53例治疗无应答组【分别为(48.5±7.4)mg/L和(35.5±6.3)μg/L,P<0.05】。结论 CHC合并NAFLD患者血清RBP4和SREBP-1c水平升高,可能影响对干扰素-α2a抗病毒治疗的应答,值得进一步研究。

Objective The aim of this study was to explore the implication of serum retinol-binding protein 4(RBP4) and sterol regulatory element-binding protein-1c(SREBP-1c) in patients with chronic hepatitis C(CHC) and non-alcoholic fatty liver diseases(NAFLD). Methods A total of 94 patients with CHC were admitted to our hospital between February 2019 and February 2022, and all underwent liver biopsy and were treated with recombinant human interferon-α 2a and ribavirin for 24 weeks. The homeostasis model assessment of insulin resistance(HOMA-IR) was calculated. Serum RBP4 and SREBP-1c levels were detected by ELISA. Results The liver histopathological examination revealed NAFLD in 50 cases(53.2%), including 22(44.0%) with mild and 28(56.0%) with moderate-severe(M/S) steatosis in our series;serum AST, ALT, ALP and GGT levels in patients with M/S steatosis were(62.2±12.8)U/L,(87.2±11.5)U/L,(99.0±14.4)U/L and(69.4±10.3)U/L, much higher than [(53.6±10.1)U/L,(75.7±12.5)U/L,(83.8±12.7)U/L and(58.5±7.7)U/L, respectively, P<0.05] in patients with mild steatosis or [(51.7±8.5)U/L,(73.5±13.8)U/L,(81.6±10.9)U/L and(56.2±8.1)U/L, respectively, P<0.05] in patients with CHC;serum RBP4 and SREBP-1c levels in patients with M/S steatosis were(55.9±8.2) mg/L and(40.1±7.4)μg/L, significantly higher than [(36.7±5.8)mg/L and(29.3±5.1)μg/L, respectively, P<0.05] in patients with mild steatosis or [(28.4±6.3)mg/L and(21.8±5.5)μg/L, P<0.05] in patients with CHC;serum HbA1c and HOMA-IR in patients with M/S steatosis were(5.7±0.5)% and(3.2±0.5), both significantly higher than [(5.3±0.5)% and(2.5±0.4), P<0.05] in patients with mild steatosis or [(5.1±0.3)% and(1.9±0.3), P<0.05] in patients with CHC;serum RBP4 and SREBP-1c levels in 41 patients who responded to interferon-α 2a therapy were(25.7±6.0)mg/L and(20.6±5.0)μg/L, much lower than [(48.5±7.4)mg/L and(35.5±6.3)μg/L, P<0.05] in 53 patients who didn’t. Conclusion Serum RBP4 and SREBP-1c levels in patients with CHC and NAFLD increase, which might interferes with antiviral therapy, and warrants further investigation.