非酒精性脂肪肝患者肝功能、氧化应激水平变化及临床意义

doi:10.3969/j.issn.1673-8640.2020.09.011

摘要/Abstract

摘要：

目的探讨非酒精性脂肪肝患者肝功能、氧化应激水平变化及其临床意义,为患者临床诊疗提供相关指导。方法选取120例非酒精性脂肪肝患者作为研究组,并选取同期100名体检健康者作为对照组。对比2个组受试者肝功能及氧化应激水平,采用Pearson相关性分析检测肝功能及氧化应激指标与非酒精性脂肪肝的相关性,并采用受试者工作特征（ROC）曲线分析肝功能、氧化应激水平及二者联合检测对非酒精性脂肪肝的诊断价值。结果研究组患者丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）及γ-谷氨酰基转移酶（GGT）水平分别为（43.69±6.12）U/L、（36.37±5.04）U/L、（48.07±6.41）U/L,均明显高于对照组[（23.36±3.37）U/L、（21.64±3.15）U/L、（20.85±3.08）U/L],差异有统计学意义（P<0.05）;研究组患者还原型谷胱甘肽（GSH）、丙二醛（MDA）水平分别为（321.84±42.75）μmol/L、（6.30±2.02）U/mL,均明显高于对照组[（270.61±30.37）μmol/L、（2.25±1.40）U/mL],过氧化氢酶（CAT）、总超氧化物歧化酶（SOD）水平分别为（40.72±6.20）U/mL、（80.27±11.78）U/mL,均明显低于对照组[（53.42±6.91）U/mL、（92.82±12.27）U/mL],差异有统计学意义（P<0.05）;Pearson相关性分析结果显示,肝功能指标及GSH、MDA水平与非酒精性脂肪肝呈正相关（r=0.835、0.722、0.741,P<0.05）,CAT、SOD水平与非酒精性脂肪肝呈负相关（r=-0.685、-0.712,P<0.05）;ROC曲线分析结果显示,二者联合检测的曲线下面积（AUC）、敏感性及特异性分别为0.862、86.79%、93.24%,均明显高于肝功能、氧化应激水平单独检测的0.670、62.03%、81.82%和0.754、77.64%、64.55%（P<0.05）。结论非酒精性脂肪肝患者肝功能及氧化应激损伤较为严重,受试者肝功能及GSH、MDA水平越高,CAT、SOD水平越低,发生非酒精性脂肪肝的风险越大;肝功能及氧化应激水平联合检测可以有效提高诊断非酒精性脂肪肝的敏感性和特异性,值得被临床广泛应用。

关键词: 肝功能, 氧化应激, 非酒精性脂肪肝

Abstract:

Objective To investigate the changes and clinical significance of liver function and oxidative stress in patients with nonalcoholic fatty liver,and to provide a reference for clinical diagnosis and treatment. Methods A total of 120 patients with nonalcoholic fatty liver were enrolled as study group,and 100 healthy subjects were enrolled as control group. The liver function and oxidative stress were compared between the 2 groups. The correlation of liver function and oxidative stress with nonalcoholic fatty liver was analyzed by Pearson single factor analysis,and the diagnostic value of liver function,oxidative stress and the combined determination in patients with nonalcoholic fatty liver was analyzed by receiver operating characteristic（ROC）curve. Results The levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST） and gamma-glutamyltransferase（GGT） in study group [（43.69±6.12） U/L,（36.37±5.04） U/L,（48.07±6.41） U/L] were higher than those in control group [（23.36±3.37） U/L,（21.64±3.15） U/L,（20.85±3.08） U/L]（P<0.05）. The levels of glutathione（GSH） and malondialdehyde（MDA） in study group were （321.84±42.75）μmol/L and （6.30±2.02）U/mL,which were higher than those in control group [（270.61±30.37） μmol/L,（2.25±1.40） U/mL]. The levels of catalase（CAT） and total superoxide dismutase（SOD） were （40.72±6.20）U/mL and （80.27±11.78）U/mL,which were lower than those in control group [（53.42±6.91） U/mL,（92.82±12.27） U/mL]（P<0.05）. Pearson correlation analysis showed that liver function,GSH and MDA levels were positively correlated with nonalcoholic fatty liver（r=0.835,0.722 and 0.741,P<0.05）,and CAT and SOD levels were negatively correlated with nonalcoholic fatty liver（r=-0.685 and -0.712,P<0.05）. ROC curve analysis showed that the area under curve（AUC）,sensitivity and specificity of the combined determination were 0.862,86.79% and 93.24%,respectively,which were higher than those of the single determinations of liver function and oxidative stress（0.670,62.03%,81.82%;0.754,77.64%,64.55%）（P<0.05）. Conclusions Nonalcoholic fatty liver patients have severe liver function and oxidative stress damage. The higher the liver function,GSH and MDA levels are,and the lower the CAT and SOD levels are,the greater the risk of nonalcoholic fatty liver is. The combined determination of liver function and oxidative stress can effectively improve the sensitivity and specificity in the diagnosis of nonalcoholic fatty liver,and it is worthy of clinical application.

Key words: Liver function, Oxidative stress, Nonalcoholic fatty liver

中图分类号:

R446.1

王永斌, 陆奎英, 苏勇, 张俊, 刘付弟. 非酒精性脂肪肝患者肝功能、氧化应激水平变化及临床意义[J]. 检验医学, 2020, 35(9): 903-907.

WANG Yongbin, LU Kuiying, SU Yong, ZHANG Jun, LIU Fudi. Changes and clinical significance of liver function and oxidative stress in patients with nonalcoholic fatty liver[J]. Laboratory Medicine, 2020, 35(9): 903-907.

图/表 3

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组别	例数	GSH/（μmol/L）	MDA/（U/mL）	CAT/（U/mL）	SOD/（U/mL）
对照组	100	270.61±30.37	2.25±1.40	53.42±6.91	92.82±12.27
研究组	120	321.84±42.75	6.30±2.02	40.72±6.20	80.27±11.78
t值		18.736	7.947	10.561	10.033
P值		0.000	0.006	0.002	0.002

组别	例数	GSH/（μmol/L）	MDA/（U/mL）	CAT/（U/mL）	SOD/（U/mL）
对照组	100	270.61±30.37	2.25±1.40	53.42±6.91	92.82±12.27
研究组	120	321.84±42.75	6.30±2.02	40.72±6.20	80.27±11.78
t值		18.736	7.947	10.561	10.033
P值		0.000	0.006	0.002	0.002