CAJ | 학술논문

目的：探讨成纤维细胞生长因子21（FGF‐21）与非酒精性脂肪性肝病（NAFLD）进展的相关性，无创预测诊断非酒精性脂肪性肝炎（NASH）。方法选取NAFLD患者80例，正常健康人群50例作为对照。测量身高、体质量、腰围等生理指标，计算BMI；检测ALT、AST、AST／ALT、ALP、GGT、TC、TG、HDL、LDL等生化指标；双抗夹心法测定血清中FGF‐21浓度水平。结果血清FGF‐21与AST及低密度脂蛋白胆固醇具有相关性（P＜0．05），与肝细胞脂肪变性、气球样变、小叶内炎症、汇管区炎症及纤维化程度呈高度相关（P＜0．01）；随 NAS评分增高其浓度增大，呈高度正相关（r＝0．881，P＜0．01）；NASH患者血清中FGF‐21明显高于Non‐NASH患者（t＝0．127，P＜0．01），经ROC曲线分析，AUC＝0．977，利用Youden指数确定最佳敏感性为97．4％，特异性为91．7％，最佳cut‐off 值为40．76 ng／L ，具有较高的诊断能力。结论 NASH患者血清FGF‐21水平明显升高，血清FGF‐21可作为评价NASH及其严重程度的独立预测因子，可以作为一个无创性诊断指标对NASH进行诊断。
목적：탐토성섬유세포생장인자21（FGF‐21）여비주정성지방성간병（NAFLD）진전적상관성，무창예측진단비주정성지방성간염（NASH）。방법선취NAFLD환자80례，정상건강인군50례작위대조。측량신고、체질량、요위등생리지표，계산BMI；검측ALT、AST、AST／ALT、ALP、GGT、TC、TG、HDL、LDL등생화지표；쌍항협심법측정혈청중FGF‐21농도수평。결과혈청FGF‐21여AST급저밀도지단백담고순구유상관성（P＜0．05），여간세포지방변성、기구양변、소협내염증、회관구염증급섬유화정도정고도상관（P＜0．01）；수 NAS평분증고기농도증대，정고도정상관（r＝0．881，P＜0．01）；NASH환자혈청중FGF‐21명현고우Non‐NASH환자（t＝0．127，P＜0．01），경ROC곡선분석，AUC＝0．977，이용Youden지수학정최가민감성위97．4％，특이성위91．7％，최가cut‐off 치위40．76 ng／L ，구유교고적진단능력。결론 NASH환자혈청FGF‐21수평명현승고，혈청FGF‐21가작위평개NASH급기엄중정도적독립예측인자，가이작위일개무창성진단지표대NASH진행진단。
Objective To investigate the correlation between fibroblast growth factor (FGF) 21 and progression of non‐alcoholic fatty liver disease (NAFLD) and its non‐invasive diagnostic value .Methods Eighty cases confirmed diagnosis of NAFLD by liver biopsy were enrolled .Liver biopsy tissues were collected ,and serum samples were collected 1 week before biopsy .Fifty cases diagnosed of no fatty liver by B‐ultrasound were enrolled as controls .Measurements of height , weight ,waist circumference and other physiological indicators were carried out ,and body mass index (BMI) were calculated .Levels of alanine aminotransferase (ALT ) , aspartate aminotransferase (AST ) , AST / ALT , alkaline phosphatase (ALP) ,gamma‐glutamyl transpeptidase (GGT) ,total cholesterol (TC) ,triglyceride (TG) ,high density lipoprotein (HDL) ,low density lipoprotein (LDL) and other biochemical markers were detected .Enzyme‐linked immuno‐sorbent assay (ELISA) was performed to determine the concentration of serum FGF‐21 .Results Serum level of FGF‐21 was associated with AST and LDL (P< 0 .05) ,and highly correlated with hepatic steatosis ,ballooning degeneration , lobular inflammation ,periportal inflammation and fibrosis degree (P<0 .01) .Serum level of FGF‐21 increased with NAS score increasing ,which indicated a high‐positive correlation (r=0 .881 ,P<0 .01) .Furthermore ,serum level of FGF‐21 in non alcoholic steatohepatitis (NASH) patients was significantly higher than that in non‐NASH patients (t=0 .127 , P<0 . 01) by receiver operating characteristic(ROC) curve analysis (AUC=0 .977) .Optimum sensitivity ,specificity and the best cut‐off value were determined by Youden index as 97 .4% ,91 .7% and 40 .76 ng/L ,respectively ,which revealed high diagnostic value of FGF‐21 .Conclusion Serum levels of FGF‐21 in patients with NASH were significantly increased ,which could be an independent predictor to evaluate NASH and its severity and a non‐invasive diagnostic indicator for NASH .