血清Maresin-1水平变化对非酒精性脂肪性肝病的影响

Effect of serum Maresin-1 level on nonalcoholic fatty liver disease

目的探讨Maresin-1(MaR1)与非酒精性脂肪性肝病(NAFLD)患者肝组织学特征的关系。方法选取2021年1月至2022年2月NAFLD患者126例,CHB患者120例。比较NAFLD组、CHB组临床资料,同时分析各肝组织学特征NAFLD患者MaR1水平变化,构建ROC曲线并计算AUC值,比较血清MaR1对不同肝脏组织学表现NAFLD患者的诊断效能。结果NAFLD组BMI显著高于CHB组[(27.3±3.4)mg/m^(2)比(22.5±2.7)mg/m^(2),(P<0.05)];CHB组FBG为(4.8±1.0)mmol/L,NAFLD组为(5.7±1.0)mmol/L(P<0.05);NAFLD组ALT、AST、TC、TG、UA、LDL及Scr分别为(38.0±5.2)U/L、(34.8±5.0)U/L、(5.0±0.7)mmol/L、(2.0±0.5)mmol/L、(5.2±0.6)μmol/L、(3.4±0.5)mmol/L及(70.5±14.6)μmol/L,CHB组分别为(26.8±4.3)U/L、(23.0±4.1)U/L、(4.6±0.6)mmol/L、(1.2±0.4)mmol/L、(4.7±0.4)μmol/L、(3.0±0.5)mmol/L及(63.3±12.9)μmol/L(P<0.05)。NAFLD组HDL显著低于CHB组[(1.1±0.3)mmol/L比(1.4±0.4)mmol/L(P<0.05)。CHB组MaR1为(79.1±5.5)pg/mL,NAFLD组为(63.6±4.3)pg/mL(P<0.05)。肝纤维化分期F0期18例,F1期26例,F2期44例,F3期23例及F4期15例,各肝纤维化MaR1分别为(78.8±5.7)、(73.0±5.0)、(65.2±4.4)、(60.4±4.5)和(57.0±4.4)pg/mL,差异有统计学意义(P<0.05);肝组织炎症程度1级29例,2级62例、3级23例以及4级12例,各肝组织炎症程度MaR1分别为(75.6±5.4)、(66.9±4.8)、(60.6±5.3)和(50.2±5.0)pg/mL,差异有统计学意义(P<0.05);NAFLD患者肝脂肪变程度S0级25例,S1级46例,S2级35例及S3级20例,各肝脂肪变程度MaR1分别为(77.8±5.2)pg/mL、(72.4±5.1)pg/mL、(64.0±4.4)pg/mL及(61.3±4.6)pg/mL,差异有统计学意义(P<0.05)。血清MaR1在评估肝纤维化分期≥F2、肝组织炎症活动度分级≥2以及肝脂肪变程度≥S2时的截断点分别为68.2、70.5以及66.6 pg/mL,AUC分别为0.78、0.77及0.87。结论NAFLD患者中血清MaR1水平显著下降,可预测NAFLD的发生。

Objective To compare the clinical data of nonalcoholic fatty liver disease(NAFLD)and chronic hepatitis B(CHB),and to explore the relationship between Maresin-1(MaR1)and liver histological features of NAFLD patients,including liver fibrosis stages,and liver inflammation and fatty liver degrees.Methods From January 2021 to February 2022,126 NAFLD patients(NAFLD group)were selected,including 75 males and 51 females,with an average age of(44.3±8.4)years.In the same period of time,120 patients with CHB(CHB group)were selected as the control group,including 63 males and 57 females,aged(41.6±7.3)years.The diagnosis of NAFLD and CHB met the requirements.The clinical data of NAFLD group and CHB group were compared,and the changes of MaR1 level in patients with NAFLD were analyzed.receiver operator characteristic curve(ROC)was constructed,The value of area under the curve(AUC)was calculated,and the cutoff point of serum MaR1 for NAFLD patients with different liver histology was analyzed.Results BMI of NAFLD group and CHB group was(27.3±3.4)mg/m^(2)and(22.5±2.7)mg/m^(2),the difference was statistically significant(P<0.05).Compared with CHB group[(4.8±1.0)mmol/L],FBG in NAFLD group increased significantly[(5.7±1.0)mmol/L,P<0.05].The levels of ALT,AST,TC,TG,UA,LDL and Scr in NAFLD group were(38.0±5.2)U/L,(34.8±5.0)U/L(5.0±0.7)mmol/L,(2.0±0.5)mmol/L,(5.2±0.6)mmol/L,(3.4±0.5)mmol/L and(70.5±14.6)μmol/L,compared with CHB group[(26.8±4.3)U/L,(23.0±4.1)U/L,(4.6±0.6)mmol/L,(1.2±0.4)mmol/L,(4.7±0.4)μmol/L,(3.0±0.5)and(63.3±12.9)μmol/L,the difference was statistically significant(P<0.05).The HDL levels in NAFLD group and CHB group were(1.1±0.3)mmol/L and(1.4±0.4)mmol/L,and the difference was statistically significant(P<0.05).Compared with CHB group[(79.1±5.5)pg/mL],MaR1 in NAFLD group decreased significantly[(63.6±4.3)pg/mL,P<0.05].The liver fibrosis stages were F0 stage in 18 cases,F1 stage in 26 cases,F2 stage in 44 cases,F3 stage in 23 cases and F4 stage in 15 cases.The MaR1 of each liver fibrosis was(78.8±5.7)pg/mL,(73.0±5.0)pg/mL,(65.2±4.4)pg/mL,(60.4±4.5)pg/mL and(57.0±4.4)pg/mL,respectively,the difference was statistically significant(P<0.05).The degree of liver inflammation was grade 1 in 29 cases,grade 2 in 62 cases,grade 3 in 23 cases and grade 4 in 12 cases,the inflammatory degree of each liver tissue MaR1 was(75.6±5.4)pg/mL,(66.9±4.8)pg/mL,(60.6±5.3)pg/mL and(50.2±5.0)pg/mL,respectively,the difference was statistically significant(P<0.05).In patients with NAFLD,the degree of hepatic steatosis was S0 in 25 cases,S1 in 46 cases,S2 in 35 cases and S3 in 20 cases.The degree of hepatic steatosis MaR1 was(77.8±5.2)pg/mL(72.4±5.1)pg/mL,(64.0±4.4)pg/mL and(61.3±4.6)pg/mL,respectively,the difference was statistically significant(P<0.05).The cut-off points of serum MaR1 were 68.2 pg/mL,70.5 pg/mL and 66.6pg/mL,respectively,when evaluating liver fibrosis stage≥F2,liver tissue inflammatory activity grade≥2 and liver steatosis degree≥S2,the corresponding AUC values are 0.78,0.77 and 0.87,respectively.Conclusion Serum MaR1 level in patients with NAFLD decreased significantly,which can be used to predict and prevent the occurrence of NAFLD.