血清组织蛋白酶D检测在非酒精性脂肪性肝病中的临床意义

doi:10.3969/j.issn.1673-8640.2020.06.013

摘要/Abstract

摘要：

目的探讨血清组织蛋白酶D（CTSD）在非酒精性脂肪肝性病（NAFLD）中的临床意义。方法选取NAFLD患者356例,按疾病严重程度将NAFLD患者分为轻度组（146例）、中度组（113例）和重度组（97例）,另选取体检健康者300名作为正常对照组。检测所有对象的血清CTSD、丙氨酸氨基转移酶（ALT）,天门冬氨酸氨基转移酶（AST）、γ-谷氨酰基转移酶（GGT）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）。采用Pearson相关分析和Spearman等级相关分析评估各项目之间及其与NAFLD严重程度的相关性。采用受试者工作特征（ROC）曲线评估各项指标诊断NAFLD的价值。结果 NAFLD组血清ALT、TC、TG、LDL-C、CTSD水平高于正常对照组（P<0.01）,且NAFLD各组之间差异亦有统计学意义（P<0.01）。NAFLD组血清AST、GGT水平高于正常对照组（P<0.01）,且NAFLD重度组高于中度组（P<0.01）,NAFLD轻度组与正常对照组之间血清AST、GGT水平差异无统计学意义（P>0.05）。血清CTSD与NAFLD的严重程度呈正相关（r_s=0.800 5,P<0.000 1）,与ALT、TC、LDL-C亦呈正相关（r值分别为0.541、0.662、0.571,P<0.01）。ROC曲线分析显示,CTSD、ALT、GGT诊断NAFLD的曲线下面积（AUC）分别为0.940、0.822、0.627,最佳临界值分别为12.67 pg/mL、38.00 U/L、53.00 U/L,敏感性分别为76.97%、51.69%、34.55%、特异性分别为91.33%、93.00%、92.33%。CTSD与ALT联合检测诊断NAFLD的AUC为0.960,敏感性和特异性分别为88.48%和90.00%。结论 CTSD与NAFLD的进展密切相关,或可作为NAFLD早期诊断及分级的标志物。

关键词: 组织蛋白酶D, 非酒精性脂肪性肝病, 生物标志物

Abstract:

Objective To investigate the clinical role of serum cathepsin D（CTSD） in non-alcoholic fatty liver disease（NAFLD）. Methods A total of 356 NAFLD patients were enrolled and classified into 3 groups according to ultrasound diagnosis,which were mild group（146 patients）,moderate group（113 patients） and advanced group（97 patients）. Totally,300 healthy subjects were enrolled as control group. Serum levels of CTSD,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,gamma-glutamyltransferase（GGT）,triglyceride（TG）,total cholesterol（TC） and low-density lipoprotein cholesterol（LDL-C） were determined. Pearson correlation analysis and Spearman correlation analysis were used to assess the correlation between each indicator and the severity of NAFLD. Receiver operating characteristic（ROC） curve was used to evaluate the diagnosis value of these indicators. Results Serum levels of ALT,TC,TG,LDL-C and CTSD in NAFLD group were higher than those in control group（P<0.01）,which had statistical significance among NAFLD groups（P<0.01）. Compared with control group,serum levels of AST and GGT were increased in NAFLD group （P<0.01）,and those in advanced group were higher than those in moderate group（P<0.01）,while there was no statistical significance between control and mild groups（P>0.05）. Serum CTSD was positively correlated with the severity of NAFLD （r_s=0.800 5,P<0.000 1）,ALT（r=0.541,P<0.01）,TC（r=0.662,P<0.01） and LDL-C（r=0.571,P<0.01）. ROC curve analysis showed that the areas under curves（AUC） of CTSD,ALT and GGT in the diagnosis of NAFLD were 0.940,0.822 and 0.627,respectively. The optimal cut-off values were 12.67 pg/mL,38.00 U/L and 53.00 U/L,respectively. The sensitivities were 76.97%,51.69% and 34.55%,and the specificities were 91.33%,93.00% and 92.33%,respectively. The AUC of CTSD combined with ALT determination in the diagnosis of NAFLD was 0.960,the sensitivity was 88.48%,and the specificity was 90.00%. Conclusions Serum level of CTSD is correlated with the severity of NAFLD,and it can be used as a biomarker for the early diagnosis and staging of NAFLD.

Key words: Cathepsin D, Non-alcoholic fatty liver disease, Biomarker

中图分类号:

R556

王茜青, 洪娟, 杜超, 褚庆华. 血清组织蛋白酶D检测在非酒精性脂肪性肝病中的临床意义[J]. 检验医学, 2020, 35(6): 578-582.

WANG Qianqing, HONG Juan, DU Chao, CHU Qinghua. Clinical role of serum cathepsin D determination in non-alcoholic fatty liver disease[J]. Laboratory Medicine, 2020, 35(6): 578-582.

图/表 5

参考文献 15

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组别	例数	ALT/（U/L）	AST/（U/L）	GGT/（U/L）
NAFLD组	356	40.60±16.32^*	35.21±13.86^*	46.31±24.26^*
轻度组	146	31.34±8.06^*	27.69±7.36^*	34.15±14.34^*
中度组	113	40.09±9.05^*#	32.65±8.58^*#	45.95±18.46^*#
重度组	97	55.9±20.26^*#△	50.16±14.59^*#△	65.76±29.37^*#△
正常对照组	300	24.70±9.61	27.65±7.27	35.00±13.39
组别	TG/（mmol/L）	TC/（mmol/L）	LDL-C/（mmol/L）	CTSD/（pg/mL）
NAFLD组	1.95±0.50^*	5.52±0.97^*	3.65±0.55^*	18.45±7.18^*
轻度组	1.61±0.30^*	4.91±0.49^*	3.38±0.33^*	14.25±3.53^*
中度组	2.00±0.33^*#	5.41±0.36^*#	3.59±0.3^*#	18.31±5.72^*#
重度组	2.44±0.47^*#△	6.67±0.73^*#△	4.19±0.46^*#△	25.24±7.58^*#△
正常对照组	1.01±0.48	2.81±1.37	1.95±1.00	7.20±3.76

组别	例数	ALT/（U/L）	AST/（U/L）	GGT/（U/L）
NAFLD组	356	40.60±16.32^*	35.21±13.86^*	46.31±24.26^*
轻度组	146	31.34±8.06^*	27.69±7.36^*	34.15±14.34^*
中度组	113	40.09±9.05^*#	32.65±8.58^*#	45.95±18.46^*#
重度组	97	55.9±20.26^*#△	50.16±14.59^*#△	65.76±29.37^*#△
正常对照组	300	24.70±9.61	27.65±7.27	35.00±13.39
组别	TG/（mmol/L）	TC/（mmol/L）	LDL-C/（mmol/L）	CTSD/（pg/mL）
NAFLD组	1.95±0.50^*	5.52±0.97^*	3.65±0.55^*	18.45±7.18^*
轻度组	1.61±0.30^*	4.91±0.49^*	3.38±0.33^*	14.25±3.53^*
中度组	2.00±0.33^*#	5.41±0.36^*#	3.59±0.3^*#	18.31±5.72^*#
重度组	2.44±0.47^*#△	6.67±0.73^*#△	4.19±0.46^*#△	25.24±7.58^*#△
正常对照组	1.01±0.48	2.81±1.37	1.95±1.00	7.20±3.76