代谢相关脂肪性肝病患者血清YKL-40 NOX2表达与肝纤维化的关系

Relationship between serum YKL-40 and NOX2 expression and liver fibrosis in patients with metabolic-associated fatty liver disease

目的 探究代谢相关脂肪性肝病(MAFLD)患者血清几丁质酶样蛋白40(YKL-40)、烟酰胺腺嘌呤二核苷酸磷酸氧化酶2(NOX2)表达水平,并分析其与肝纤维化的关系。方法 选取2020年4月至2021年12月于保定市人民医院就诊的108例MAFLD患者为MAFLD组,选取同期该院108例健康体检者为对照组。肝纤维化程度评估根据瞬时弹性成像技术所得肝脏硬度值分为非纤维化组(60例,肝脏硬度值<8.0 k Pa)和纤维化组(48例,肝脏硬度值≥8.0 k Pa)。比较研究对象YKL-40、NOX2及临床资料差异。logistic回归分析MAFLD患者发生肝纤维化的影响因素。受试者工作特征(ROC)曲线评价YKL-40、NOX2对肝纤维化的预测效能。结果 MAFLD组血清YKL-40、NOX2水平高于对照组,差异有统计学意义(P<0.05)。纤维化组YKL-40、NOX2水平高于非纤维化组,差异有统计学意义(P<0.05)。回归分析显示,年龄(OR=1.647,95%CI:1.053~2.575,P=0.029)、HOMA-IR(OR=1.758,95%CI:1.083~2.853,P=0.022)、YKL-40(OR=2.016,95%CI:1.237~3.284,P=0.004)、NOX2(OR=2.292,95%CI:1.388~3.786,P=0.001)是MAFLD患者发生肝纤维化的影响因素(P<0.05)。YKL-40、NOX2单独预测MAFLD患者肝纤维化的曲线下面积(AUC)分别为0.833、0.838,YKL-40联合NOX2预测MAFLD患者肝纤维化的AUC为0.922,优于单一指标(Z_(二者联合-YKL-40)=2.268,P=0.023、Z_(二者联合-NOX2)=1.999,P=0.046)。结论 YKL-40、NOX2在MAFLD患者血清中水平增加,且与肝纤维化相关,YKL-40联合NOX2可作为预测肝纤维化的生物标志物。

Objective To investigate the expression levels of serum chitinase-like protein 40(YKL-40)and nicotinamide adenine dinucleotide phosphate oxidase 2(NOX2)in patients with metabolism-associated fatty liver disease(MAFLD),and to analyze their relationship with liver fibrosis.Methods From April 2020 to December 2021,108 MAFLD patients(MAFLD group)and 108 healthy subjects(control group)who were treated in Baoding People’s Hospital were gathered.The evaluation of liver fibrosis degree was divided into non-fibrosis group(60 cases,liver stiffness value<8.0 kPa)and fibrosis group(48 cases,liver stiffness value≥8.0 kPa)according to the liver stiffness value obtained by transient elastography.The differences in YKL-40,NOX2 and the clinical data were compared.Logistic regression analysis was used to analyze the influencing factors of liver fibrosis in MAFLD patients.The predictive power of YKL-40 and NOX2 for liver fibrosis was evaluated by ROC curve.Results The serum levels of YKL-40 and NOX2 in the MAFLD group were lower than those in the control group(P<0.05).The levels of YKL-40 and NOX2 in fibrosis group were significantly higher than those in non-fibrosis group(P<0.05).Regression analysis showed that,age(OR=1.647,95%CI:1.053~2.575,P=0.029),HOMA-IR(OR=1.758,95%CI:1.083~2.853,P=0.022),YKL-40(OR=2.016,95%CI:1.237~3.284,P=0.004),NOX(OR=2.292,95%CI:1.388~3.786,P=0.001)were the influencing factors of hepatic fibrosis in MAFLD patients(P<0.05).The area under the curve(AUC)of YKL-40 and NOX2 independently predicted liver fibrosis in MAFLD patients was 0.833 and 0.838,respectively,and the AUC of YKL-40 combined with NOX2 predicted liver fibrosis in MAFLD patients was 0.922.It was better than a single index(Z_(both combined-YKL-40)=2.268,P=0.023,Z_(both combined-NOX2)=1.999,P=0.046).Conclusions The serum levels of YKL-40 and NOX2 in MAFLD patients rise,and they are related to liver fibrosis.YKL-40 combined with NOX2 can be used as a biomarker for predicting liver fi‐brosis.