非酒精性脂肪性肝病患者血清Chemerin水平的变化及其意义

发布时间：2017-12-28 03:05

本文关键词：非酒精性脂肪性肝病患者血清Chemerin水平的变化及其意义　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨非酒精性脂肪性肝病(NAFLD)患者血清Chemerin水平的变化及其意义。方法:选取2014年1月至2014年12月于河北省故城县医院内科住院患者共72例(男性47例,女性25例),平均年龄59.41±9.08岁作为试验组。随机取健康体检人群102例(男性63例,女性39例),平均年龄61.07±6.73岁作为对照组。试验组应符合以下入选标准(参照2010年中华医学会肝病分会非酒精性脂肪性肝病诊疗指南):(1)无饮酒史或饮酒量140g/周(女性70g/周)。(2)腹部超声学检查符合弥漫性脂肪肝变的影像特征。(3)签署知情同意。所有受试对象排除标准:病毒性肝炎、药物性肝炎、自身免疫性肝病、肝豆状核变性、全胃肠外营养、甲状腺功能亢进或减退、恶性肿瘤、血液系统疾病、阻塞性睡眠呼吸暂停、严重的感染及心肺功能不全、多囊卵巢综合症(PCOS)、处于妊娠期、哺乳期及口服避孕药女性、及可导致脂肪肝的其他疾病。根据血清Chemerin检测值高低,将所有研究对象分为三个亚组,分别为较低水平组(65.14ng/ml)54例、中间水平组(65.14-79.29ng/ml)69例、较高水平组(79.29ng/ml)51例。腹部超声影像学检查用于筛选实验对象,反映肝脏脂肪浸润的类型,判断脂肪肝的程度,提示是否存在显性肝硬化。脂肪肝超声影像学诊断标准(参照2010年中华医学会肝病分会非酒精性脂肪性肝病诊疗指南):(1)肝区近场回声弥漫性增强,强于脾脏和肾脏,远场回声逐渐衰减;(2)肝内管道结构显示不清;(3)肝脏轻至中度肿大,边缘圆钝;(4)彩色多普勒血流显像提示肝内彩色血流信号减少或不易显示,但肝内血管走形正常;(5)肝右叶包膜及横隔回声显示不清或不完整。依据腹部超声影像学检查结果,将实验组再分为三个亚组:轻度组、中度组、重度组。具备上述第1项及第2-4项中一项者为轻度脂肪肝(21例),具备上述第1项及第2-4项中两项者为中度脂肪肝(27例),具备上述第1项以及第2-4项中两项和第5项者为重度脂肪肝(24例)。调查并记录所有研究对象性别、年龄、职业、既往史(心、脑、肝、肾等疾病)、家族史、吸烟史、用药史、饮食习惯等。由专人测量身高、体重,计算体重指数bmi=体重(kg)/身高(m2),并测量血压、心率,行全身体格检查,必要时行腹部ct检查。研究对象空腹12小时以上,于入院后第二日清晨采静脉血,应用我院瑞士罗氏cobas-8000全自动生化分析仪测定空腹血糖(fbg)、空腹胰岛素(fins)、糖化血红蛋白(hbalc)、甘油三酯(tg)、总胆固醇(chol)、低密度脂蛋白胆固醇(ldl-c)、高密度脂蛋白胆固醇(hdl-c)、超敏c反应蛋白(hs-crp)等生化指标。计算胰岛素抵抗指数(homa-ir)。另采静脉血5ml,采用酶联免疫吸附法检测血清chemerin水平。应用spss19.0版统计软件对所有实验数据进行统计学分析,符合正态分布的计量资料以均数±标准差表示,计数资料以百分比表示,两组间比较采用t检验,多组均数比较采用单因素方差分析(one-wayanova),计数资料采用χ2检验,双变量采用pearson相关分析,相关程度分析采用logistic逐步回归分析,以p0.05认为有统计学差异。结果:1一般临床资料比较试验组与对照组相比,在年龄、性别、高血压患病率、吸烟史上无显著性差异(p0.05)。而bmi试验组高于对照组(27.80±3.12kg/m2vs23.21±3.24kg/m2),差异有统计学意义(p0.05)。2血清chemerin检测值水平的比较试验组血清chemerin检测值水平高于对照组(81.02±13.11ng/mlvs62.21±12.32ng/ml),差异有统计学意义(p0.01)。3相关生化指标比较与对照组相比,试验组的生化指标chol(5.12±0.63mmol/lvs4.31±1.05mmol/l)、tg(2.25±1.42mmol/lvs1.52±1.21mmol/l)、ldl-c(3.62±0.55mmol/lvs2.45±0.87mmol/l)、hbalc(5.91±0.31%vs5.21±0.47%)、fbg(5.80±1.62mmol/lvs5.05±1.89mmol/l)、hs-crp(3.17±1.31mmol/lvs1.24±0.84mmol/l)以及homa-ir(3.51vs2.68),均高于对照组(p0.05),而其hdl-c(1.41±0.26mmol/lvs1.73±0.37mmol/l)低于对照组(p0.05)。4不同chemerin检测值水平的各亚组间比较较高水平组相比较低水平组,bmi、tg、homa-ir、hs-crp升高,差异有统计学意义(p0.05),HDL-C水平降低,差异有统计学意义(P0.05)。5 NAFLD组内各亚组间比较重度脂肪肝组血清Chemerin水平、HOMA-IR、hs-CRP高于中度NAFLD组和轻度NAFLD组,差异有统计学意义(P0.05)。6血清Chemerin水平与各项指标的相关性分析在试验组中,血清Chemerin的水平与BMI、TG、CHOL、LDL、FBG、HOMA-IR、hs-CRP呈正相关(r值为0.406、0.496、0.284、0.426、0.322、0.528,0.301 P均0.05),与HDL-C呈负相关(r=-0.376,P0.05)。7以是否发生非酒精性脂肪肝为因变量,以性别、年龄、是否患有高血压、HOMA-IR、HAblc、TG、CHOL、LDL-C、HDL-C、hs-CPR、Chemerin为自变量,进行Logistic逐步回归分析,结果显示,Chemerin是发生非酒精性脂肪性肝病的危险因素(OR=2.071,P0.01)。校正年龄、性别、BMI、血糖、血脂、HOMA-IR,以Chemerin为自变量,以Chemerin最低分位低水平组为参照,行Logistic回归分析,结果显示中间水平组和高水平组OR值分别为2.835,4.933(P0.01)。结论:1非酒精性脂肪性肝病患者血清Chemerin呈高水平表达状态,且随病情加重,血清Chemerin呈逐步增高趋势;2血清Chemerin检测值水平与hs-CRP、HOMA-IR等生化指标具有相关性;3较高水平的Chemerin可能是发生非酒精性脂肪性肝病的危险因素。
[Abstract]:Objective: To explore the changes and significance of serum Chemerin level in patients with nonalcoholic fatty liver disease (NAFLD). Methods: a total of 72 hospitalized patients (47 males and 25 females) aged from 59.41 to 9.08 years old in Hebei Gucheng county hospital from January 2014 to December 2014 were selected as the experimental group. 102 patients (63 males and 39 females) were randomly selected for physical examination. The average age was 61.07 + 6.73 years old as the control group. The experimental group should meet the following selection criteria (refer to the guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease of the Chinese Medical Association 2010): (1) no alcohol history or alcohol consumption for 140g/ weeks (female 70g/ weeks). (2) abdominal ultrasound examination accords with the imaging features of diffuse fatty liver change. (3) sign informed consent. All subjects were excluded: viral hepatitis, drug hepatitis, autoimmune liver disease, hepatolenticular degeneration, total parenteral nutrition, hyperthyroidism or hypothyroidism, malignant tumor, blood system disease, obstructive sleep apnea, infection and cardiopulmonary dysfunction and polycystic ovary syndrome (PCOS), during pregnancy, breast-feeding women and oral contraceptives, and other diseases can lead to fatty liver. According to the level of serum Chemerin, all the subjects were divided into three sub groups, which were 54 cases of lower level group (65.14ng/ml), 69 cases of intermediate level group (65.14-79.29ng/ml), and 51 cases of higher level group (79.29ng/ml). The abdominal ultrasound examination was used to screen the subjects, to reflect the type of liver fat infiltration, to determine the degree of fatty liver, and to suggest the existence of dominant cirrhosis. Criteria for the diagnosis of fatty liver ultrasound imaging (reference to the 2010 Chinese Medical Association of nonalcoholic fatty liver disease liver disease diagnosis and treatment guidelines): (1) liver area near field echo diffuse enhancement in the spleen and kidney, the far field echo decays; (2) hepatic duct structure was not clear; (3) liver mild to moderate swelling, rounded edge; (4) color Doppler flow imaging color blood flow signal in the liver to reduce or not easy to show, but the intrahepatic vessel shape is normal; (5) the right lobe of the liver capsule and diaphragm echo showed unclear or incomplete. According to the results of abdominal ultrasonography, the experimental group was divided into three subgroups: mild group, moderate group and severe group. Among the above first and 2-4 items, one is mild fatty liver (21 cases). Among the above first and 2-4, two cases are moderate fatty liver (27 cases), and those with first items and 2-4 items two and fifth are severe fatty liver (fifth cases). The sex, age, occupation and past history of all subjects (heart, brain, liver and kidney diseases), family history, smoking history, medication history and eating habits were investigated and recorded. By hand, body height and weight to calculate body mass index (kg) bmi= weight / height (M2), and the measurement of blood pressure, heart rate, whole body examination, if necessary, abdominal CT examination. Fasting 12 hours on the morning of the second day after admission, the venous blood was collected in our hospital, application of Roche cobas-8000 automatic biochemical analyzer determination of fasting blood glucose (FBG), fasting insulin (fins), glycosylated hemoglobin (HbAlc), triglyceride (TG), total cholesterol (Chol), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), high sensitive C reactive protein (hs-CRP) and other biochemical indicators. The insulin resistance index (HOMA-IR) was calculated. 5ml was extracted from venous blood, and serum Chemerin was detected by enzyme linked immunosorbent assay (ELISA). Application of spss19.0 statistical software for statistical analysis of all experimental data with normal distribution measurement data to mean + standard deviation, count data expressed as a percentage between the two groups using t test, multiple groups were compared using single factor analysis of variance (one-wayanova), count data using 2 test, double variables using Pearson correlation analysis, correlation analysis using logistic regression analysis to P0.05 that there were significant differences. Results: 1 compared with the control group, there was no significant difference in age, sex, the prevalence of hypertension and the history of smoking (P0.05) compared with the control group. The BMI test group was higher than the control group (27.80 + 3.12kg/m2vs23.21 + 3.24kg/m2), and the difference was statistically significant (P0.05). 2 the level of serum Chemerin was significantly higher than that of the control group (81.02 + 13.11ng/mlvs62.21 + 12.32ng/ml). The difference between the two groups was statistically significant (P0.01). The level of serum Chemerin level in the test group was higher than that in the control group. 3 related biochemical indicators compared with the control group, biochemical indexes of Chol in the experimental group (5.12 + 0.63mmol/lvs4.31 + 1.05mmol/l), TG (2.25 + 1.42mmol/lvs1.52 + 1.21mmol/l), LDL-C (3.62 + 0.55mmol/lvs2.45 + 0.87mmol/l), HbAlc (5.91 + 0.31%vs5.21 + 0.47%), FBG (5.80 + 1.62mmol/lvs5.05 + 1.89mmol/l, hs-CRP (3.17 +) 1.31mmol/lvs1.24 + 0.84mmol/l) and HOMA-IR (3.51vs2.68), were higher than the control group (P0.05), and HDL-C (1.41 + 0.26mmol/lvs1.73 + 0.37mmol/l) than in the control group (P0.05). 4, the levels of BMI in different levels of Chemerin were higher than those in low level group. BMI, TG, HOMA-IR and hs-CRP increased. The difference was statistically significant (P0.05), and HDL-C level was decreased (P0.05). The 5 group NAFLD subgroup comparison between severe fatty liver group serum levels of Chemerin, HOMA-IR, hs-CRP higher than the moderate NAFLD group and mild NAFLD group, the difference was statistically significant (P0.05). Correlation between serum Chemerin level and 6 indexes analysis in the experimental group, was positively correlated with the levels of BMI and serum Chemerin TG, CHOL, LDL, FBG, HOMA-IR, hs-CRP (r = 0.406, 0.496, 0.284, 0.426, 0.322, 0.528,0.301 P 0.05), and negatively correlated with HDL-C (r=-0.376, P0.05). 7, taking the occurrence of nonalcoholic fatty liver as dependent variable, taking sex, age, hypertension, HOMA-IR, HAblc, TG, CHOL, LDL-C, HDL-C, hs-CPR and Chemerin as independent variables, Logistic progressively.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R575.5

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