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目的:探究血清白介素-1受体拮抗剂(IL-1RA)与非酒精性脂肪性肝病(NAFLD)进展的相关性,以及无创性预测诊断NASH的临床价值。方法:选取确诊NAFLD病例60例,配套肝穿刺活检组织标本及肝穿前一周血清。经B超检查无脂肪肝症状的正常健康人群30例,作为对照。测量身高、体重、腰围等生理指标,计算BMI;检测ALT、AST、AST/ALT、ALP、GGT、TC、TG、HDL、LDL等生化指标;双抗夹心法测定血清中IL-1RA浓度水平。结果:血清IL-1RA与ALT、AST及GGT具有相关性(P<0.05),与肝细胞脂肪变性、气球样变、小叶内炎症、汇管区炎症及纤维化程度呈高度相关(P<0.01);随NAS评分增高其浓度增大,呈高度正相关(r=0.915,P<0.01);NASH患者血清中IL-1RA明显高于Non-NASH患者(t=2.88,P<0.01),经ROC曲线分析,曲线下面积AUROC=0.986,利用Youden指数确定最佳敏感性为89.7%,特异性为97.9%,最佳cut-off值为171.8 ng/L。结论:NASH患者血清IL-1RA水平明显升高,血清IL-1RA可作为评价NASH及其严重程度的独立预测因子,可以作为一个无创性诊断指标对NASH进行诊断。
Objective: To investigate the relationship between serum interleukin-1 receptor antagonist (IL-1RA) and the progression of non-alcoholic fatty liver disease (NAFLD) and the clinical value of noninvasive predictive value in the diagnosis of NASH. Methods: Sixty cases of confirmed NAFLD were selected, the liver biopsy specimens were collected, and the serum of one week before liver perfusion was collected. Thirty patients with normal healthy people without steatosis were selected as controls. The body weight, waist circumference and other physiological indexes were measured to calculate the BMI. The biochemical indexes such as ALT, AST, AST / ALT, ALP, GGT, TC, TG, HDL and LDL were measured. Serum levels of IL- Results: Serum IL-1RA was correlated with ALT, AST and GGT (P <0.05), and was highly correlated with steatosis, balloon degeneration, intralobular inflammation, portal inflammation and fibrosis (P <0.01) (R = 0.915, P <0.01). The level of IL-1RA in NASH patients was significantly higher than that in patients with Non-NASH (t = 2.88, P <0.01) Curve analysis, the area under the curve AUROC = 0.986, using the Youden index to determine the best sensitivity was 89.7%, the specificity was 97.9%, the best cut-off value was 171.8 ng / L. CONCLUSIONS: Serum IL-1RA levels are significantly elevated in patients with NASH. Serum IL-1RA may be an independent predictor of NASH severity and may be used as a noninvasive diagnostic indicator for NASH.