受体相互作用蛋白激酶3在非酒精性脂肪性肝病中的表达

Expression of serum RIPK3 in patients with nonalcoholic fatty liver disease

目的探讨非酒精性脂肪性肝病(NAFLD)病人血清中受体相互作用蛋白激酶3(RIPK3)的表达水平及临床意义。方法选取2019年6月至2021年6月自贡市第一人民医院收治的108例NAFLD病人作为观察组,80例体检健康者为对照组。酶联免疫吸附测定检测血清RIPK3水平,采用Pearson法分析血清RIPK3水平与肝功能指标的相关性,采用Spearman法分析血清RIPK3水平与肝组织炎症和肝纤维化分期的相关性,多因素logistic回归分析NAFLD发生的影响因素,受试者操作特征曲线(ROC曲线)分析血清RIPK3水平与肝功能指标对NAFLD的诊断价值。结果观察组和对照组身体质量指数(BMI)、腰臀比(WHR)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖均差异有统计学意义(P<0.05)。NAFLD病人血清RIPK3水平(1.12±0.34)mg/L显著高于对照组(0.69±0.27)mg/L(P<0.05)。NAFLD病人谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(GGT)水平高于对照组(P<0.05)。血清RIPK3水平与ALT、AST、GGT及肝组织炎症、肝纤维化分期均呈正相关(P<0.05)。logistic回归分析显示血清RIPK3水平、BMI、TG、ALT、AST及GGT均是NAFLD发生的影响因素(P<0.05)。血清RIPK3诊断NAFLD的AUC为0.83、灵敏度为80.56%,特异度为72.50%。血清RIPK3联合肝功能指标诊断的AUC为0.95、灵敏度为89.32%,特异度为91.67%,联合的诊断效能优于各自单独检测(ZRIPK3-联合=3.60,Z_(ALT-联合)=4.37,Z_(AST-联合)=3.41,Z_(GGT-联合)=5.14,均P<0.05)。结论血清RIPK3在NAFLD病人中的表达水平升高,与病人病情呈正相关,联合血清RIPK3与肝功能指标可提高NAFLD的诊断效能,临床应用价值较大。

Objective To investigate the expression level and clinical significance of receptor-interacting protein kinase 3(RIPK3)in serum of patients with nonalcoholic fatty liver disease.Methods From June 2019 to June 2021,108 patients with non-alcoholic fatty liver disease admitted to Zigong First People's Hospital were regarded as the observation group,and 80 healthy subjects were regarded as the control group.Serum RIPK3 level was detected by enzyme-linked immunosorbent assay,Pearson method was applied to analyze the correlation between serum RIPK3 level and liver function indexes,and Spearman method was applied to analyze the correlation between serum RIPK3 level and liver tissue inflammation and liver fibrosis stage.Multivariate logistic regression analysis was applied to analyze the influencing factors of non-alcoholic fatty liver disease,ROC curve was applied to analyze the diagnostic value of serum RIPK3 level and liver function indexes in nonalcoholic fatty liver disease.Results There were obvious differences in body mass index(BMI),waist-to-hip ratio(WHR),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)and fasting blood glucose between the observation group and the control group(P<0.05).The serum RIPK3 level in patients with NAFLD(1.12±0.34)mg/L was obviously higher than that in the control group(0.69±0.27)mg/L(P<0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)andγ-glutamyl transpeptidase(GGT)in patients with NAFLD were higher than those in the control group(P<0.05).Serum RIPK3 level were positively correlated with ALT,AST,GGT liver tissue inflammation and liver fibrosis stage(P<0.05).Logistic regression analysis showed that serum RIPK3 level,BMI,TG,ALT,AST and GGT were the influencing factors for non-alcoholic fatty liver disease(P<0.05).The AUC of serum RIPK3 for the diagnosis of NAFLD was 0.83,the sensitivity was 80.56%,and the specificity was 72.50%.The AUC of serum RIPK3 combined with liver function indexes was 0.949,the sensitivity was 89.32%,and the specificity was 91.67%,the diagnostic efficiency of the combination was better than that of the separate detections(Z_(RIPK3-combination)=3.60,Z_(ALT-combination)=4.37,Z_(AST-combination)=3.41,Z_(GGT-combination)=5.14,P<0.05).Conclusion The expression level of serum RIPK3 in patients with non-alcoholic fatty liver is increased,and it is positively correlated with the patient's condition.Combining serum RIPK3 with liver function indexes can improve the diagnostic efficiency of non-alcoholic fatty liver,and has great clinical application value.