血浆Hcy和肝纤维化指标检测在NAFLD患者中的临床应用

目的：探讨血浆同型半胱氨酸（Hcy）和肝纤维化指标检测在非酒精脂肪性肝病（NAFLD）患者中的临床意义。方法：对符合临床诊断标准的257例非酒精脂肪肝患者进行Hcy、HA、PCⅢ、CⅣ、LN检测,并以同期体检健康者作为对照。结果：单纯性NAFLD患者Hcy、HA、PCⅢ结果高于对照组,差异有显著性（P〈0.05）,而CⅣ、LN结果虽高于对照组,但增高不明显,差异无显著性（P〉0.05）,非酒精性脂肪性肝炎（NASH）患者Hcy、HA、PCⅢ、CⅣ、LN结果明显高于对照组,差异有显著性（P〈0.01）或（P〈0.05）。NAFLD患者重度组与轻、中度组之间Hcy、HA、PCⅢ、CⅣ、LN差异均有显著性（P〈0.01）,中度脂肪肝与轻度脂肪肝之间Hcy、HA、PCⅢ、CⅣ、LN差异无显著性（P〉0.05）。结论：重度NAFLD患者存在不同程度的肝纤维化趋向,Hcy、HA、PCⅢ、CⅣ、LN结果是NAFLD筛查的实验室重要指标,可作为NAFLD病情监控和疗效评估的重要依据。

Clinical Application of Determination of Changes of Plasma Hcy and Hepatic Fibrosis Markers Levels in Patients with Non-alcoholic Fatty Liver Disease(NAFLD)

Objective To study the clinical significance of changes of plasma Hcy and hepatic fibrosis markers levels in patients with NAFLD.Methods Plasma Hcy（with biochemistry） and serum HA,PCⅢ,CⅣ,LN（with RIA） levels were determined in 133 patients with uncomplicated NAFLD,124 patients with non-alcoholic steatohepatitis（NASH i.e.NAFLD complicated with ALT〉2×normal upper range over 4 weeks） and 100 controls.Results In patients with uncomplicated NAFLD,the Hcy,HA,PCⅢ levels were significantly higher than those in controls（P〈0.05）,but the CⅣ and LN levels were only insignificantly raised（P〉0.05）.In patients with NASH,the levels of Hcy and other 4 markers were all significantly higher than those in the controls（P〈0.05 or P〈0.01）.The altogether 257 patients with NAFLD could be divided into： mild（n=138）,moderate（n=74） and advanced（n=45） degrees according to the CT value.Plasma Hcy and other 4 markers levels in patients with advanced degree NAFLD were significantly higher than those in patients with NAFLD of moderate and mild degrees（P〈0.01）,but the levels in patients with mild degree of NAFLD were not significantly different from the levels in patients with moderate degree of NAFLD（P〉0.05）.Conclusion Plasma Hcy,HA,PCⅢ,CⅣ and LN levels were raised in patients with NAFLD,especially in patients with advanced degree of NAFLD and NASH.