血清IL-1RA水平与非酒精性脂肪性肝病的相关性及无创诊断的临床价值

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(P0.05),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(P0.01);随NAS评分增高其浓度增大,呈高度正相关(r=0.915,P0.01);NASH患者血清中IL-1RA明显高于Non-NASH患者(t=2.88,P0.01),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。

Study of SerumLevel of IL-1RA Level with Non-alcoholic Fatty Liver Disease and the Non-invasive Diagnostic

Objective:To research the correlation between IL-1RA in serum and the progression of NAFLD, and to discuss the clinical significance of non-invasively diagnosis.Methods:60 cases with the NAFLD who were confirmed by the liver biopsy tissue samples and serum were selected as the study group, and another 30 cases who were examined no fatty liver symptoms by B-ultrasound were chosen to be the controls. Then the height, weight, waist circumference and other physiological indicators were measured, the BMI was calculated, the ALT, AST, AST/ALT, ALP, GGT, TC, TG, HDL, LDL and other biochemical markers were detected; dual-antibody sandwich ELISA was used to determine the concentration level of serum IL-1RA.Results:Serum levels of IL-1RA is associated with ALT, AST and GGT(P<0.05); hepatic steatosis, ballooning degeneration, lobular inflammation, periportal inflammation and fibrosis were highly correlated (P<0.01); the correlation was high when the NAS rating increased its concentrations(r=0.915, P<0.01); serum levels of IL-1RA in NASH patients was significantly higher than that of the Non-NASH patients (t=2.88, P<0.01); ROC curve analysis area under the curve AUROC=0.986, the optimum sensitivity was 89.7% determined by Youden index, and the specificity was 97.9%, the best cut-off value of 171.8 ng/L.Conclusion:Patients with NASH serum levels of IL-1RA were significantly increased. Serum levels of IL-1RA can be used as an independent predictor to evaluate NASH, and used as a non-invasive diag levels of nostic indicators to diagnose NASH.