血清白介素-33对非酒精性脂肪性肝病的诊断价值分析

目的探讨IL-33对非酒精性脂肪性肝病（NAFLD）的预测诊断价值及其相关影响因素。方法选取2012年10月至2013年1月间在中山大学第三附属医院体检中心体检人群，将符合NAFLD诊断标准的140例患者纳入病例组；同时将明确排除NAFLD，不饮酒且无心血管疾病及其他慢性病，性别、年龄匹配的140名健康体检人群纳入对照组。分别对两组人群进行身高、体重、腰围、臀围、血压进行测量，对空腹静脉血的谷丙转氨酶（ALT）、谷草转氨酶（AST）、空腹血糖、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血尿酸和血清IL-33等指标进行检测。采用多因素非条件logistic回归分析以及ROC曲线的绘制，探索IL-33与非酒精性脂肪性肝病的关系。结果共研究NAFLD患者140例，其中男性87例，女性53例，平均年龄为（54．51±9．08）岁。对照组140人，男性76人，女性64人，平均年龄为（52．69±9．22）岁。两组平均年龄、性另q构成差异均无统计学意义（均P〉0．05）。NAFLD组收缩压、舒张压、体质指数（BMI）、腰围、臀围、腰臀比、ALT、TG及血尿酸均高于对照组（P〈0．01）；NAFLD组HDL-C胆固醇低于对照组（均P〈0．01）。NAFLD组超重或肥胖、高血压、血脂异常、代谢综合征以及高尿酸血症的患病率均高于对照组，差异有统计学意义（P〈0．01）；NAFLD组、对照组的血清IL-33水平分别为（3．92±1．96）、（1．92±1．31）pg／mL，NAFLD组高于对照组（P〈0．01）。高IL-33、高ALT、高TG、超重或肥胖、高血压是NAFLD的危险因素（OR=3．678、1．091、2．557、6．437、2．383）；高HDL．C是NAFLD的保护因素（OR=0．069）。IL-33预测诊断NAFLD的曲线下面积为0．819，ALT为0．665，TG为0．749，HDL—C为0．720，BMI为0．776，均具有统计学意义（均P〈0．01）。结论IL-33作为NAFLD的独立危险因素，在NAFLD的发生发展中起着重要作用，并对其具有-定的诊断价值。

Diagnosis value of serum interleukin-33 for non-alcoholic fatty liver disease

Objective To explore predictive diagnosis value of serum interleukin-33 （IL-33） for non-alcoholic fatty liver disease （NAFLD） and its relative influencing factors. Methods Participants were recruited from check-up crowd in physical examination center of the Third Affiliated Hospital, Sun Yat-sen University from October 2012 to January 2013. One hundred and forty subjects meeting the diagnostic crite- ria of NAFLD were selected as the case group and 140 healthy individuals who were non-drinkers, without cardiovascular disease or other chronic diseases, explicitly excluded from NAFLD, and matched to cases on gender and age, were taken as the control group. Height, weight, waist circumference, hip circumference, and blood pressure were measured and alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in fasting venous blood, fasting blood glucose, total cholesterol （ TC）, triglycerides （ TG）, high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, blood uric acid, and serum IL-33 were tested in both groups. Multivariate unconditional logistic regression and receiver op-erating characteristic （ROC） curve were employed to determine the association between IL-33 and NAFLD. Results The average age of the 140 NAFLD cases （87 males and 53 females） was （54. 51 ± 9.08） years （mean ± SD） and that of the 140 controls （76 males and 64 females）, （52. 69 ±9.22） years. There were no statistically significant differences in age and gender between the two groups （P 〉 0. 05 for both）. Com- pared with controls, the NAFLD cases had significantly higher levels of SBP, DBP, BMI, waist circumfer- ence, hip circumference, waist-to-hip ratio, ALT, TG, and UA, but lower HDL-C （P 〈 0. 01 for all）. The prevalence rates of obesity, hypertension, dyslipidemia, metabolic syndrome, and hyperuricemia were significantly higher in the NAFLD case group than those in the control group （P 〈 0. 01 for all）. The serum IL-33 level in NAFLD case group （3.92 ±1.96] pg/mL） was higher than that in the control group （1.92±1.31] pg/mL）, P〈0. 01. High levels of IL-33 （OR= 3. 678）,ALT （OR=1.091）, TG （OR =2. 557）,obesity （OR = 6. 437 ）, and hypertension （OR = 2. 383 ） might be the risk factors of NAFLD, while high level of HDL-C （ OR = 0. 069） might be the beneficial factor. The areas under ROC curve of IL-33, ALT, TG, HDL-C, and BMI for predictive diagnosis of NAFLD were 0. 819,0. 665,0. 749, 0. 720, and 0. 776, respectively （ P 〈 0. 01 for all ）. Conclusion As an independent risk factor for NAFLD, IL-33 played an important role in the development of NAFLD and has a high diagnosis value for it.