血清纤溶酶原激活物抑制剂1水平对非酒精性脂肪性肝病的诊断价值

目的评价血清纤溶酶原激活物抑制剂1(PAI-1)水平对非酒精性脂肪性肝病(NAFLD)特别是非酒精性脂肪性肝炎(NASH)的诊断价值。方法选择2013年7月—2017年8月在上海交通大学医学院附属第九人民医院就诊的NAFLD患者82例作为NAFLD组,然后根据肝脏组织病理学检查结果将患者分为NASH组32例和非NASH组50例(其中单纯性脂肪肝患者20例,临界NASH患者30例);选择同期参加体检的健康志愿者25例作为健康组。比较各组性别、年龄、体质量指数(BMI)、血清PAI-1水平、肝功能指标[丙氨酸转氨酶(ALT)、谷氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、AST/ALT]、血脂指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、空腹血糖(FPG),分析血清PAI-1水平与各指标的相关性,应用ROC曲线评价PAI-1对NAFLD特别是NASH的诊断价值。结果NAFLD组的性别、年龄、血清ALP水平与健康组比较差异均无统计学意义(P均>0.05),BMI及血清ALT、AST、AST/ALT、GGT、TG、TC、HDL-C、LDL-C、FPG、PAI-1水平均显著高于健康组(P均<0.05)。NASH组的性别、年龄及血清ALT、AST、AST/ALT、ALP、GGT、TC、HDL-C、LDL-C、FPG水平与非NASH组比较差异均无统计学意义(P均>0.05),BMI及血清TG、PAI-1水平均明显高于非NASH组(P均<0.05)。血清PAI-1水平与BMI、ALT、GGT、TC、TG、LDL-C、FPG均呈正相关(r=0.726,0.214,0.319,0.434,0.331,0.311,0.218,P均<0.05),与AST/ALT呈负相关(r=-0.316,P<0.05)。血清PAI-1水平诊断NAFLD和NASH的AUC值分别为0.812[95%CI(0.725,0.881)]、0.954[95%CI(0.884,0.988)],差异均有统计学意义(Z=7.766,17.901,P均<0.05)。血清PAI-1>9.71 ng/mL对预测NAFLD的敏感度为70.73%,特异度为100%。血清PAI-1>11.60 ng/mL对预测NASH的敏感度为100%,特异度为90%。结论血清PAI-1水平对NAFLD特别是NASH具有较高的诊断价值。

Diagnostic significance of serum plasminogen activator inhibitor-1 level for nonalcoholic fatty liver disease

Objective It is to evaluate the diagnostic value of serum plasminogen activator inhibitor-1(PAI-1)for nonalcoholic fatty liver disease(NAFLD),especially nonalcoholic steatohepatitis(NASH).Methods From July 2013 to August 2017,82 NAFLD patients who were treated at the Ninth People’s Hospital of Shanghai were selected as the NAFLD group,and then the patients were divided into NASH group(n=32)and non-NASH group(n=50)(including 20 patients with simple fatty liver and 30 patients with borderline NASH)based on the results of liver histopathology;25 healthy volunteers who participated in physical examination during the same period were selected as the healthy group.The gender,age,BMI,serum PAI-1 level,liver function indicators(ALT,AST,ALP,GGT,AST/ALT),blood lipid indicators(TC,TG,LDL-C,HDL-C),fasting blood glucose(FPG)of every group were compared,the correlation between serum PAI-1 level and every indicators was analyzed,and ROC curve was used to evaluate the diagnostic value of PAI-1 on NAFLD,especially NASH.Results There was no significant difference in gender,age,and serum ALP level between the NAFLD group and the healthy group(P>0.05),the levels of BMI and serum ALT,AST,AST/ALT,GGT,TG,TC,HDL-C,LDL-C,FPG,and PAI-1 in NAFLD group were significantly higher than those in the healthy group(P<0.05).There was no significant difference in gender,age,and serum ALT,AST,AST/ALT,ALP,GGT,TC,HDL-C,LDL-C,and FPG between the NASH group and the non-NASH group(P>0.05),the levels of BMI and serum TG and PAI-1 were significantly higher than those in non-NASH group(P<0.05).Serum PAI-1 levels were positively correlated with BMI,ALT,GGT,TC,TG,LDL-C,and FPG(r=0.726,0.214,0.319,0.434,0.331,0.311,0.218,P<0.05),and negatively correlated with AST/ALT(r=-0.316,P<0.05).The AUC values of serum PAI-1 levelfor the diagnosis of NAFLD and NASH were 0.812[95%CI(0.725,0.881)]and 0.954[95%CI(0.884,0.988)],respectively,and the differences were significant(Z=7.766,17.901,P<0.05).The sensitivity of serum PAI-1>9.71 ng/mL to predict NAFLD was 70.73%,and the specificity was 100%.The sensitivity of serum PAI-1>11.60 ng/mL to predict NASH was 100%,and the specificity was 90%.Conclusion Serum PAI-1 level has high diagnostic value for NAFLD,especially NASH.