四种非传染性肝病的体检人员肝脏相关血清学标志物的调查分析

Analysis of liver-related serologic markers of four noninfectious liver diseases in the health examination population

目的探究体检人群中脂肪肝、肝囊肿、肝血管瘤、脂肪肝合并肝囊肿的肝脏相关血清学标志物。方法以深圳市萨米医疗中心2018年9月至2020年8月的体检人群为研究对象,根据肝胆B超检查结果,肝病可分为单一肝病和肝病合并症,因而分为对照组和4个非传染性肝病组,采用Mann-Whitney U检验,比较各组的肝功能和血脂指标。结果共纳入8938例体检者(男性n=4986,女性n=3952)为研究对象。男性中,脂肪肝组高密度脂蛋白胆固醇(HDLC)1.10(0.96,1.26)mmol/L低于对照组1.33(1.14,1.53)mmol/L(P<0.05),丙氨酸氨基转移酶(ALT)30.7(21.8,45.0)U/L、天门冬氨酸氨基转移酶(AST)22.0(18.3,27.6)U/L、总胆固醇5.18(4.59,5.81)mmol/L、低密度脂蛋白胆固醇(LDLC)3.40(2.85,3.98)mmol/L高于对照组[19.0(14.1,26.3)U/L、19.0(16.4,22.3)U/L、4.81(4.28,5.38)mmol/L、3.11(2.62,3.65)mmol/L](P<0.05);脂肪肝合并肝囊肿组ALT 24.0(18.0,35.0)U/L、AST 21.0(18.0,26.0)U/L、HDLC 1.00(1.00,1.00)mmol/L低于脂肪肝组[30.7(21.8,45.0)U/L、22.0(18.3,27.6)U/L、1.10(0.96,1.26)mmol/L](P<0.05);HDLC 1.00(1.00,1.00)mmol/L低于肝囊肿组1.31(1.13,1.52)mmol/L(P<0.05),ALT 24.0(18.0,35.0)U/L、AST 21.0(18.0,26.0)U/L、总胆固醇5.00(5.00,6.00)mmol/L高于肝囊肿组[18.5(14.8,24.0)U/L、19.2(16.6,22.3)U/L、4.88(4.29,5.63)mmol/L](P<0.05)。女性中,脂肪肝组HDLC 1.31(1.14,1.48)mmol/L低于对照组1.61(1.41,1.83)mmol/L(P<0.05),ALT 17.5(13.1,24.8)U/L、AST 17.9(15.2,22.4)U/L、总胆固醇5.10(4.52,5.76)mmol/L、LDLC 3.36(2.74,3.93)mmol/L高于对照组[11.3(9.0,14.9)U/L、16.2(14.2,18.7)U/L、4.52(4.05,5.05)mmol/L、2.70(2.28,3.18)mmol/L](P<0.05);肝囊肿组总胆固醇4.77(4.28,5.40)mmol/L、LDLC 2.88(2.48,3.38)mmol/L高于对照组[4.52(4.05,5.05)mmol/L、2.70(2.28,3.18)mmol/L](P<0.05);肝血管瘤组肝功能和血脂指标与对照组的均差异无统计学意义(P>0.05);脂肪肝合并肝囊肿组HDLC 1.00(1.00,1.00)mmol/L低于脂肪肝组1.31(1.14,1.48)mmol/L和肝囊肿组1.61(1.39,1.84)mmol/L(P<0.05);ALT 18.0(14.0,28.0)U/L、AST 20.0(16.0,22.0)U/L高于肝囊肿组[11.6(9.2,15.7)U/L、16.4(14.2,19.4)U/L](P<0.05)。结论肝功能和血脂指标是诊断和监测脂肪肝以及脂肪肝合并肝囊肿的理想指标,但在单纯的肝囊肿或肝血管瘤中的意义较为有限。

Objective To explore liver-related serologic markers of fatty liver,hepatic cysts,hepatic hemangioma,and fatty liver combined with hepatic cysts in a health examination population.Methods The health examination population of Shenzhen Samii Medical Center from September 2018 to August 2020 was used as the study population.According to the results of hepatobiliary B-ultrasound,liver disease can be divided into single liver disease and liver disease complications and thus divided into a control group and four noninfectious liver disease groups,and the Mann-Whitney U test was used to compare the liver function and lipid indices of each group.Results A total of 8938 subjects included(male n=4986 and female n=3952)with health examination were included in the study.In males,high-density lipoprotein cholesterol(HDLC)of 1.10(0.96,1.26)mmol/L in the fatty liver group was lower than that of the control group of 1.33(1.14,1.53)mmol/L(P<0.05),and alanine aminotransferase(ALT)of 30.7(21.8,45.0)U/L,aspartate aminotransferase(AST)of 22.0(18.3,27.6)U/L,total cholesterol of 5.18(4.59,5.81)mmol/L,low density lipoprotein cholesterol(LDLC)of 3.40(2.85,3.98)mmol/L in the fatty liver group were higher than those in the control group[19.0(14.1,26.3)U/L,19.0(16.4,22.3)U/L,4.81(4.28,5.38)mmol/L,3.11(2.62,3.65)mmol/L](P<0.05);ALT of 24.0(18.0,35.0)U/L,AST of 21.0(18.0,26.0)U/L and HDLC of 1.00(1.00,1.00)mmol/L of the fatty liver combined with hepatic cyst group were lower than those in the fatty liver group[30.7(21.8,45.0)U/L,22.0(18.3,27.6)U/L,1.10(0.96,1.26)mmol/L](P<0.05),and HDLC of 1.00(1.00,1.00)mmol/L was lower than that in the hepatic cyst group of 1.31(1.13,1.52)mmol/L(P<0.05),ALT of 24.0(18.0,35.0)U/L,AST of 21.0(18.0,26.0)U/L and total cholesterol of 5.00(5.00,6.00)mmol/L were higher than those in the hepatic cyst group[18.5(14.8,24.0)U/L,19.2(16.6,22.3)U/L and 4.88(4.29,5.63)mmol/L](P<0.05).In females,HDLC of 1.31(1.14,1.48)mmol/L in the fatty liver group was lower than that in the control group of 1.61(1.41,1.83)mmol/L(P<0.05),and ALT of 17.5(13.1,24.8)U/L,AST of 17.9(15.2,22.4)U/L,total cholesterol of 5.10(4.52,5.76)mmol/L,LDLC of 3.36(2.74,3.93)mmol/L in the fatty liver group were higher than those in the control group[11.3(9.0,14.9)U/L,16.2(14.2,18.7)U/L,4.52(4.05,5.05)mmol/L,2.70(2.28,3.18)mmol/L](P<0.05);total cholesterol of 4.77(4.28,5.40)mmol/L and LDLC of 2.88(2.48,3.38)mmol/L in the hepatic cyst group were higher than those in the control group[4.52(4.05,5.05)and 2.70(2.28,3.18)mmol/L](P<0.05).There was no statistically significant difference between the liver function and lipid indices in the hepatic hemangioma group and control group(P>0.05);the HDLC of 1.00(1.00,1.00)mmol/L in the fatty liver combined with hepatic cyst group was lower than that of the fatty liver group[1.31(1.14,1.48)mmol/L]and that of the hepatic cyst group[1.61(1.39,1.84)mmol/L](P<0.05);ALT of 18.0(14.0,28.0)U/L and AST of 20.0(16.0,22.0)U/L in the fatty liver combined with hepatic cyst group were higher than those of the liver cyst group[11.6(9.2,15.7)U/L and 16.4(14.2,19.4)U/L](P<0.05).Conclusion The liver function and lipid indices were ideal for the diagnosis and monitoring of fatty liver and fatty liver combined with hepatic cyst but are of more limited significance in simple hepatic cysts or hepatic hemangioma.