血清YKL-40对非酒精性脂肪肝肝纤维化的预测作用

目的探讨非酒精性脂肪肝患者血清中YKL-40水平及在肝纤维化程度评价中的价值。方法2017年7月至2019年7月于我院就诊的NAFLD患者142例,根据是否发生肝纤维化分为纤维化组(n=60)与非纤维化组(n=82),另纳入40例健康体检者作为健康对照组,采用放射免疫分析法测定血清中透明质酸(HA)、III型前胶原(PC III)、IV型胶原(CIV)及层粘连蛋白(LN)水平。采用双夹心抗体ELISA法检测血清YKL-40水平。结果三组研究对象年龄、性别、BMI指数等一般性资料差异无统计学意义(P>0.05);健康对照组、S0~S4期血清YKL-40水平随着肝纤维化分期的不断增加而不断升高(P<0.05)。血清YKL-40水平与NFS、FIB-4、APRI评分均呈显著正相关关系,具有统计学意义(P<0.05)。ROC分析结果表明,当Cutoff值为158 ng/mL时,YKL-40对NAFLD患者肝纤维化诊断价值最高,其AUC、灵敏度、特异性、PPV、NPV等均高于传统肝纤维化指标,差异具有统计学意义(P<0.05)。结论血清YKL-40在非酒精性脂肪肝患者中水平明显升高,对肝纤维化具有良好的预测价值。

The Predictive Effect of Serum YKL-40 on Liver Fibrosis in Nonalcoholic Fatty Liver Disease

Objective To investigate the serum levels of YKL-40 in patients with nonalcoholic fatty liver disease and its value in the evaluation of liver fibrosis.Methods Between July,2017 and July,2019,142 patients with NAFLD who were treated in our hospital were enrolled into the fibrosis group(n=60)and non-fibrosis group(n=82)according to whether hepatic fibrosis occurred.In addition,40 cases were included as the healthy control group.All subjects were tested for serum levels of hyaluronic acid(HA),type III procollagen(PC III),type IV collagen(CIV),and laminin(LN)by radioimmunoassay.Detection of serum YKL-40 levels was conducted by double sandwich antibody ELISA.Results There were no significant differences in the general data of age,gender,and BMI index among the three groups(P>0.05).The serum YKL-40 levels in the healthy control group and S0-S4 stages were 35.6±4.8 ng/mL,90.5±7.7 ng/mL,131.4±8.3 ng/mL,157.0±8.5 ng/mL,206.9±10.5 ng/mL and 290.7±11.3 ng/mL,respectively.As the stage of liver fibrosis increased,serum YKL levels increased(P<0.05)as well.Serum YKL-40 levels were significantly positively correlated with-NFS,FIB-4,and APRI scores(P<0.05).ROC analysis showed that YKL-40 had the highest diagnostic value for liver fibrosis in patients with NAFLD when the cutoff value was 158 ng/mL.The AUC,sensitivity,specificity,PPV,and NPV were all higher than the traditional liver fibrosis index with significant differences(P<0.05).Conclusion Serum YKL-40 is significantly elevated in patients with nonalcoholic fatty liver disease and has a good predictive value for liver fibrosis.