非酒精性脂肪性肝病患者血清脂联素、维生素D和载脂蛋白B水平变化及其临床意义探讨

Changes of serum adiponectin, vitamin D and apolipoprotein B levels in patients with nonalcoholic fatty liver disease

目的 探讨非酒精性脂肪性肝病(NAFLD)患者血清脂联素(APN)、25-羟维生素D[25]-(OH)D]和载脂蛋白B(ApoB)水平变化及其临床意义。方法 2018年8月~2021年5月我院诊治的NAFLD患者117例和健康体检者51例,使用Fibroscan行肝脏硬度检测(LSM)和受控衰减参数(CAP)检查。采用化学发光法检测血清25-(OH)D水平,采用ELISA法检测血清APN和ApoB水平。结果 本组NAFLD患者包括单纯性脂肪肝组37例、非酒精性脂肪性肝炎(NASH)58例和脂肪性肝硬化22例;根据LSM水平,无肝纤维化81例和进展期肝纤维化36例;NAFLD组血清APN和25-(OH)D水平分别为(9.7±1.9)μg/mL和(30.8±6.4)nmol/L,显著低于健康人【分别为(12.9±2.7)μg/mL和(57.9±8.1)nmol/L,P<0.05】,而血清ApoB水平为(1.2±0.2)g/L,显著高于健康人【(0.7±0.1)g/L,P<0.05】;脂肪性肝硬化组血清APN和25-(OH)D水平分别为(7.9±1.3)μg/mL和(24.3±6.9)nmol/L,显著低于NASH组【分别为(9.2±2.1)μg/mL和(30.5±7.4)nmol/L,P<0.05】或单纯性脂肪肝组【分别为(11.5±2.5)μg/mL和(35.1±7.1)nmol/L,P<0.05】,而血清ApoB水平为(1.5±0.2)g/L,显著高于NASH组【(1.3±0.3)g/L,P<0.05】或单纯性脂肪肝组【(0.9±0.1)g/L,P<0.05】;进展期肝硬化患者血清APN和25-(OH)D水平分别为(8.1±1.4)μg/mL和(25.3±6.7)nmol/L,显著低于无肝纤维化患者【分别为(10.4±2.2)μg/mL和(33.2±7.5)nmol/L,P<0.05】,而血清ApoB水平为(1.6±0.3)g/L,显著高于无肝纤维化患者【(1.0±0.2)g/L,P<0.05】。结论 NAFLD患者存在血清APN、25-(OH)D和ApoB异常变化,监测这些变化可能有助于判断病情,值得进一步研究。

Objective The aim of this study was to explore the implication of serum adiponectin(APN), 25-hydroxyvitamin D [25-(OH)D] and apolipoprotein B(ApoB) level changes in patients with nonalcoholic fatty liver disease(NAFLD). Methods A total of 117 patients with NAFLD and 51 healthy individuals were enrolled in our hospital between August 2018 and May 2021, and all underwent liver stiffness measurement(LSM) by Fibroscan. Serum 25-(OH)D level was detected by chemiluminescence, and serum APN and ApoB levels were detected by ELISA. Results Based on the controlled attenuated parameters(CAP), the simple fatty liver(SFL) was found in 37 cases, the non-alcoholic steatohepatitis(NASH) was found in 58 cases and the fatty liver-induced cirrhosis was found in 22 cases, and out of them, no liver fibrosis was determined in 81 patients with NAFLD and progressive liver fibrosis in 36 cases;serum APN and 25-(OH)D levels in patients with NAFLD were(9.7±1.9)μg/mL and(30.8±6.4)nmol/L, both significantly lower than [(12.9±2.7)μg/mL and(57.9±8.1)nmol/L, respectively, P<0.05], while serum ApoB level was(1.2±0.2)g/L, significantly higher than [(0.7±0.1)g/L, P<0.05] in healthy persons;serum APN and 25-(OH)D levels in patients with cirrhosis were(7.9±1.3)μg/mL and(24.3±6.9)nmol/L, both significantly lower than [(9.2±2.1)μg/mL and(30.5±7.4)nmol/L, respectively, P<0.05] in patients with NASH or [(11.5±2.5)μg/mL and(35.1±7.1)nmol/L, respectively, P<0.05] in patients with SFL, while serum ApoB level was(1.5±0.2)g/L, significantly higher than [((1.3±0.3)g/L, P<0.05] in patients with NASH or [(0.9±0.1)g/L, P<0.05] in patients with SFL;serum APN and 25-(OH)D levels in patients with progressive liver fibrosis were(8.1±1.4)μg/mL and(25.3±6.7)nmol/L, both significantly lower than [(10.4±2.2)μg/mL and(33.2±7.5)nmol/L, P<0.05], while serum ApoB level was(1.6±0.3)g/L, significantly higher than [(1.0±0.2)g/L, P<0.05] in patients without liver fibrosis. Conclusion Serum APN, 25-(OH)D and ApoB levels are abnormal in patients with NAFLD, which might help predict the disease severity and the progression of liver fibrosis.