非酒精性脂肪性肝病患者肝组织脂联素表达及其意义

目的探讨肝组织脂联素表达在非酒精性脂肪性肝病（NAFLD）发病机制中的作用及地位,为NAFLD的预防及治疗提供新的思路。方法47例NAFLD患者及20例正常对照均测量身高、体重,计算体重指数（BMI）;分别应用ELISA方法测定血清脂联素（adiponectin）浓度、血清肿瘤坏死因子-α（TNF-α）浓度;采用稳态模式评估法,计算胰岛素抵抗指数（HOMA-IR）;对肝组织进行HE、Masson染色及脂联素免疫组化染色,对脂联素表达量进行半定量分析。结果非酒精性脂肪性肝炎（NASH）组肝组织脂联素表达较对照组及单纯性脂肪肝组显著减少（P〈0.05）,与血清脂联素浓度呈显著正相关（P〈0.01）,与血清TNF-α浓度、ALT、HOMA-IR及肝组织炎症、纤维化程度呈负相关（P〈0.01）,而与脂变程度不相关（P〉0.05）。多元线性逐步回归分析显示,肝组织脂联素表达是肝组织炎症及纤维化发生的保护因素。结论肝组织脂联素表达在NAFLD患者肝组织炎症及纤维化发生发展中起保护性作用。

Expression and significance of adiponectin in liver of patients with nonalcoholic fatty liver disease

Objective To investigate the changes of expression of adiponectin in the liver and their significance in patients with nonalcoholic fatty liver disease（NAFLD）.Methods 47 patients with NAFLD and 20 healthy subjects were chosen in our study.Serum adiponectin and tumor necrosis factor-α（TNF-α） were quantified by enzyme linked immunosorbent assay（ELISA）.The levels of body mass index（BMI）,alanine aminotransferase（ALT）,fasting blood glucose and fasting insulin were also assayed.Insulin resistance（IR） was estimated by using the homeostasis model assessment（HOMA）.The histological manifestation of liver was analyzed by HE and Masson staining.The expression of adiponectin in the liver was detected by immuno histochemical staining,and the relative quantity of adiponectin was assessed by semiquantitative analysis.Results The relative quantity of adiponectin in liver of NASH patients was remarkably lower than that in simple steatotic liver and normal liver.The expression of adiponectin in the liver was positively correlated with the levels of serum adiponectin,and negatively correlated with the levels of serum TNF-α,ALT,HOMA-IR and the degree of hepatic inflammation and fibrosis.The multivariant linear gradual regressive analysis showed that the expression of adiponectin in the liver was a protective factor of hepatic inflammation and fibrosis.Conclusion The expression of adiponectin in the liver acts as a protective factor in the development of inflammation and fibrosis in NAFLD.