血清胰脂肪酶、血管生成素样蛋白4在诊断非酒精性脂肪性肝病中的临床意义

摘要/Abstract

摘要： 目的探讨血清胰脂肪酶(P-LIP)、血管生成素样蛋白4(ANGPTL4)在非酒精性脂肪性肝病(NAFLD)中的变化及临床意义。方法选取2018年2月至2020年10月江苏省宿迁市中医院收治的NAFLD患者128例,并选择同一时间段进行体检的120例健康者为对照组。对比两组研究对象血清P-LIP、ANGPTL4水平。并依据腹部超声检查将NAFLD患者分为轻度组(69例)、中度组(36例)和重度组(23例),对比不同严重程度NAFLD患者血清P-LIP、ANGPTL4水平;制作受试者工作特征曲线(ROC),分析血清P-LIP、ANGPTL4及其两者联合检测对NAFLD的诊断效能。结果 NAFLD组血清P-LIP水平为(27.5±8.1)U/L,低于对照组的(38.1±9.8)U/L(t=9.308,P<0.05),NAFLD组血清ANGPTL4水平为(172.7±75.3)ng/mL,高于对照组的(145.3±65.4)ng/mL(t=3.051,P＜0.05)。不同严重程度NAFLD患者血清P-LIP、ANGPTL4水平对比差异均有统计学意义(t=11.357、7.518,均P＜0.05);重度组NAFLD患者血清P-LIP均于轻度组和中度组(t=4.295、2.467,均P＜0.05),中度组NAFLD患者血清P-LIP低于轻度组(t=2.009,P<0.05);重度组NAFLD患者血清NGPTL4均显著高于轻度组和中度组(t=4.417、2.047,均P＜0.05),中度组NAFLD患者血清ANGPTL4高于轻度组(t=2.332,P<0.05)。ROC分析显示,血清P-LIP、ANGPTL4对NAFLD患者进行诊断的最佳截断点分别为33.6 U/L、164.2 ng/mL,两者联合诊断的特异度为96.7%,高于血清P-LIP、ANGPTL4单独进行诊断的特异度(70.8%、60.8%),血清P-LIP、ANGPTL4联合诊断NAFLD患者的曲线下面积(AUC)为0.874,高于血清P-LIP、ANGPTL4单独诊断的AUC(0.718、0.663)(Z=4.015,4.042;P=0.003、0.001),且血清P-LIP、ANGPTL4两者联合诊断NAFLD患者与腹部超声检查结果的一致性较好(Kappa=0.715,P=0.008)。结论联合检测血清P-LIP、ANGPTL4对NAFLD的诊断较高,可作为NAFLD诊断的重要参考指标。

关键词: 血清胰脂肪酶, 血管生成素样蛋白4, 非酒精性, 脂肪性肝病

Abstract: Objective To investigate the changes and clinical value of serum pancreatic lipase (P-LIP) and angiopoietin-like protein 4 (ANGPTL4) in non-alcoholic fatty liver disease (NAFLD).Methods A total of 128 NAFLD patients admitted to this hospital from February 2018 to October 2020 were selected as the study group, and 120 healthy patients who underwent physical examination in the hospital during the same time period were selected as the control group. The serum P-LIP and ANGPTL4 levels of the two groups of study subjects were compared. the NAFLD patients were divided into mild group (69 cases), moderate group (36 cases) and severe group (23 cases) based on abdominal ultrasound examination, and the different severity levels were compared Serum P-LIP and ANGPTL4 levels in NAFLD patients. Make receiver operating characteristic curve (ROC) to analyze the diagnostic efficacy of serum P-LIP, ANGPTL4 and their combination for NAFLD.Results The systolic blood pressure, diastolic blood pressure, alanine aminotransferase (ALT), aspartate aminotransferase (AST), phosphocreatine kinase (CK) and total cholesterol (TC) in the study group were significantly higher than those in the control group (t=5.375, 7.669, 17.110, 9.447, 12.644, 12.213, all P<0.05). The serum P-LIP level in the study group was (27.5±8.1) U/L, which was significantly lower than the control group (38.1±9.8) U/L (t=9.308, P<0.05), and the serum ANGPTL4 level in the study group was (172.7±75.3) ng/mL, which was significantly lower It was higher than the control group (145.3±65.4) ng/mL (t=3.051, P<0.05). The serum P-LIP and ANGPTL4 levels of NAFLD patients with different severity levels were statistically different (t=11.357, 7.518, P<0.05). The serum P-LIP of NAFLD patients in the severe group was significantly lower than that in the mild group and the moderate group (t=4.295, 2.467, P<0.05). Serum P-LIP of NAFLD patients in the severe group was significantly lower than that in the mild group (t=2.009, P<0.05); serum NGPTL4 in the severe group of NAFLD patients was significantly higher than that in the mild and moderate groups (t=4.417, 2.047, P<0.05), and serum ANGPTL4 in the moderate group of NAFLD patients was significantly higher than the mild group (t=2.332, P<0.05). ROC analysis showed that the best cut-off points for the diagnosis of NAFLD patients by serum P-LIP and ANGPTL4 were 33.6 U/L and 164.2 ng/mL, respectively. The specificity of the combination of the two was 96.7%, which was higher than that of serum P-LIP and ANGPTL4. The specificity of diagnosis alone (70.8%, 60.8%), the area under the curve (AUC) of the combined diagnosis of serum P-LIP and ANGPTL4 for NAFLD patients was 0.874, which was significantly higher than the AUC (0.718, 0.663) (Z=4.015, 4.042, P=0.003, 0.001), and the combination of serum P-LIP and ANGPTL4 showed good consistency between the diagnosis of NAFLD patients and the results of abdominal ultrasound examination (Kappa=0.715, P=0.008).Conclusion The combined detection of serum P-LIP and ANGPTL4 has a higher diagnosis of NAFLD and can be used as an important reference index for the diagnosis of NAFLD.

Key words: Serum pancreatic lipase, Angiopoietin-like protein 4, Non-alcoholic, Fatty liver disease

刘刚, 熊国卫, 王玖. 血清胰脂肪酶、血管生成素样蛋白4在诊断非酒精性脂肪性肝病中的临床意义[J]. 肝脏, 2021, 26(8): 910-912.

LIU Gang, XIONG Guo-wei, WANG Jiu. Changes and clinical value of serum P-LIP and ANGPTL4 in non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2021, 26(8): 910-912.

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