【摘要】 目的观察非酒精性脂肪性肝病(NAFLD)患者血清铁代谢指标变化及其临床意义。方法收集2014年7月-2016年4月上海市第八人民医院收治的68例NAFLD患者(NAFLD组),另选取健康体检者70例(健康对照组)。68例NAFLD患者中单纯NAFLD患者24例,伴ALT异常者44例。检测所有研究对象的AST、ALT、TC、TG水平及铁代谢指标[血清铁(SI)、血清铁蛋白(SF)、血清铁调素(HEPC)]水平,观察NAFLD患者ALT异常与血清铁代谢指标的相关性。计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ~2检验,两变量间的相关性采用Pearson相关系数分析。结果 NAFLD组患者的BMI、ALT、AST、TC、TG水平均显著高于健康对照组(t值分别为9.8、8.6、8.5、9.2、2.7,P值均<0.05);铁代谢指标SI、SF水平显著高于健康对照组[SI:(21.7±7.1)μmol/L vs(18.7±6.9)μmol/L,t=2.3,P=0.02;SF:(340.2±257.6)μg/L vs(119.1±81.2)μg/L,t=6.7,P<0.01)],HEPC显著低于健康对照组[(12.2±5.3)μg/L vs(22.2±6.5)μg/L,t=9.9,P<0.01)]。伴ALT异常NAFLD患者的血清ALT、SI、SF水平显著高于单纯NAFLD患者[ALT:(89±58)U/L vs(26±8)U/L,t=7.1,P<0.01;SI:(23.4±6.2)μmol/L vs(19.6±7.9)μmol/L,t=2.2,P=0.03;SF:(406.2±290.0)μg/L vs(219.4±112.0)μg/L,t=3.7,P<0.01),血清HEPC水平显著低于单纯NAFLD患者[(7.4±4.9)μg/L vs(16.1±7.8)μg/L,t=4.7,P<0.01)]。Pearson相关性分析结果显示,SF与ALT、AST呈显著正相关(r值分别为0.28、0.34,P值分别为0.02、<0.01)。结论 NAFLD患者存在显著铁超载,且在伴ALT异常的NAFLD患者中表现更为明显。SF与ALT、AST呈显著正相关。血清铁蛋白能在一定程度上反映NAFLD患者肝损伤严重程度。更多还原

【Abstract】 Objective To investigate the changes in the serum markers of iron metabolism and their clinical significance in patients with nonalcoholic fatty liver disease( NAFLD). Methods A total of 68 NAFLD patients who were admitted to The Eighth People’ s Hospital of Shanghai from July 2014 to April 2016 were enrolled as NAFLD group,and 70 healthy persons who underwent physical examination were enrolled as healthy control group. Among the 68 patients in the NAFLD group,24 had NAFLD alone and 44 were complicated by abnormal alanine aminotransferase( ALT) level. The levels of aspartate aminotransferase( AST),ALT,total cholesterol( TC),triglyceride( TG),and serum markers of iron metabolism [serum iron( SI),serum ferritin( SF),and serum hepcidin( HEPC) ] were measured for all patients,and the correlations between abnormal ALT level and serum markers of iron metabolism were analyzed. The independent samples t- test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups,and the Pearson correlation coefficient was used to investigate the correlation between two variables. Results The NAFLD group had significantly higher body mass index and serum levels of ALT,AST,TC,and TG than the healthy control group( t = 9. 8,8. 6,8. 5,9. 2,and 2. 7,all P < 0. 05). Compared with the healthy control group,the NAFLD group had significantly higher levels of SI( 21. 7 ± 7. 1 μmol/L vs18. 7 ± 6. 9 μmol/L,t = 2. 3,P = 0. 02) and SF( 340. 2 ± 257. 6 μg/L vs 119. 1 ± 81. 2 μg/L,t = 6. 7,P < 0. 01) and a significantly lower level of HEPC( 12. 2 ± 5. 3 μg/L vs 22. 2 ± 6. 5 μg/L,t = 9. 9,P < 0. 01). Compared with those with NAFLD alone,the patients complicated by abnormal ALT level had significantly higher serum levels of ALT( 89 ± 58 U/L vs 26 ± 8 U/L,t = 7. 1,P < 0. 01),SI( 23. 4 ± 6. 2 μmol/L vs 19. 6 ± 7. 9 μmol/L,t = 2. 2,P = 0. 03),and SF( 406. 2 ± 290. 0 μg/L vs 219. 4 ± 112. 0 μg/L,t = 3. 7,P <0. 01),as well as a significantly lower serum level of HEPC( 7. 4 ± 4. 9 μg/L vs 16. 1 ± 7. 8 μg/L,t = 4. 7,P < 0. 01). The Pearson correlation analysis showed that SF was significantly positively correlated with ALT and AST( r = 0. 28 and 0. 34,P = 0. 02 and P < 0. 01).Conclusion NAFLD patients have significant iron overload,especially in NAFLD patients complicated by abnormal ALT level. SF is significantly positively correlated with ALT and AST. To a certain degree,SF can reflect the severity of liver injury in NAFLD patients.更多还原