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膜微粒在非酒精性脂肪性肝炎中的诊断价值
Value of microparticles in the diagnosis of nonalcoholic steatohepatitis
文章发布日期:2019年08月19日  来源:  作者:陈俊,李良平,付万智  点击次数:102次  下载次数:9次

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【摘要】:目的 探讨血浆中CD14+细胞群和恒定自然杀伤T淋巴细胞(iNKT)源性膜微粒(MP)水平在非酒精性脂肪性肝炎(NASH)中的诊断价值。方法 纳入2015年3月-2015年11月四川省人民医院消化内科、肝胆外科接受肝活组织检查的非酒精性脂肪性肝病(NAFLD)患者(36例),根据NAFLD活动度积分(NAS)和肝纤维化分期,分为NASH组(n=22)和非NASH 组(n=14)。对照组为年龄、性别等因素匹配的健康体检者(n=15)。采用流式细胞术检测受试者血浆CD14+细胞和iNKT细胞的MP水平。符合正态分布的计量资料2组间比较采用t检验;多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;非正态分布的计量资料2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ2检验,两变量相关采用Pearson相关性分析。应用受试者工作特征曲线(ROC曲线)评价MP的诊断价值。结果 NAFLD组血浆CD14+细胞MP水平高于对照组[(5.92±062)个/μl vs (4.52±0.42)个/μl,t=7.160,P<0.001]、iNKT细胞MP水平高于对照组[(438±0.51)个/μl vs (3.79±0.28)个/μl, t=3.966,P<0.001]。NASH组血浆CD14+细胞MP水平高于非NASH组[(6.25±0.48)个/μl vs (5.44±0.49)个/μl,t=4773,P<0.001]、iNKT细胞MP水平高于非NASH组[(4.70±039)个/μl vs (3.96±026)个/μl,t=6.544,P<0001]。3组血浆CD14+细胞MP、iNKT细胞MP组间比较,差异均有统计学意义(F值分别为61.039、42.285,P值均<0.05);进一步两两比较,NASH组血浆MP水平高于非NASH组,NASH组血浆MP水平高于对照组,非NASH组血浆MP水平高于对照组,差异均有统计学意义(P值均<0.05)。血浆CD14+细胞MP、iNKT细胞MP水平与NAS积分呈正相关(r值分别为0.697、0.793,P值均<0.001)。CD14+细胞MP诊断NASH的ROC曲线下面积为0.886(95%可信区间:0.750~1.000,P<0.001),敏感度为909%,特异度为856%;iNKT细胞MP诊断NASH的ROC曲线下面积为0.935(95%可信区间:0.822~1.000,P<0.001),敏感度为81.8%,特异度为92.9%。结论NASH患者血浆CD14+细胞MP和iNKT细胞MP水平增高,且其水平与肝脏炎症程度呈正相关,或可作为判断肝脏炎症的潜在无创指标。
【Abstract】:ObjectiveTo investigate the value of plasma levels of microparticles (MPs) derived from CD14+ cells and invariant natural killer T (iNKT) cells in the diagnosis of nonalcoholic steatohepatitis (NASH). MethodsA total of 36 patients with nonalcoholic fatty liver disease (NAFLD) who underwent liver biopsy in Department of Gastroenterology and Department of Hepatobiliary Surgery, Sichuan Provincial People’s Hospital, from March to November 2015, were enrolled, and according to the activity score of NAFLD and fibrosis stage, the patients were divided into NASH group with 22 patients and non-NASH group with 14 patients. A total of 15 individuals, matched for age and sex, who underwent physical examination were enrolled as control group. Flow cytometry was used to measure the plasma levels of MPs derived from CD14+ cells and iNKT cells in all subjects. The t-test was used for comparison of normally distributed continuous data between groups; the t-test was used for comparison of non-normally distributed continuous data which became normally distributed after logarithmic transformation between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test was used for comparison of categorical data between two groups. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Pearson correlation analysis was used to investigate the correlation between two variables, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of MP. ResultsCompared with the control group, the NAFLD group had significantly higher plasma levels of MPs from CD14+ cells (5.92±062 cells/μl vs 4.52±0.42 cells/μl, t=7.160, P<0.001) and MPs from iNKT cells (4.38±0.51 cells/μl vs 3.79±028 cells/μl, t=3.966, P<0.001). Compared with the non-NASH group, the NASH group had significantly higher plasma levels of MPs from CD14+ cells (6.25±0.48 cells/μl vs 5.44±0.49 cells/μl, t=4.773, P<0.001) and MPs from iNKT cells (470±0.39 cells/μl vs 3.96±0.26 cells/μl, t=6.544, P<0.001). There were significant differences in the plasma levels of MPs from CD14+ cells and iNKT cells between the three groups (F=61.039 and 42.285, both P<0.05); the NASH group had significantly higher plasma levels of MPs than the non-NASH group and the control group, and the non-NASH group had significantly higher plasma levels of MPs than the control group (all P<0.05). The plasma levels of MPs from CD14+ cells and iNKT cells were positively correlated with NAFLD activity score (r=0.697 and 0.793, both P<0.001). MPs from CD14+ cells had an area under the ROC curve (AUC) of 0886 (95% confidence interval [CI]: 0.750-1.000, P<0.001) in the diagnosis of NASH, with a sensitivity of 909% and a specificity of 85.6%; MPs from iNKT cells had an AUC of 0.935 (95% CI: 0.822-1.000, P<0.001), with a sensitivity of 81.8% and a specificity of 92.9%. ConclusionThere are increases in the plasma levels of MPs from CD14+ cells and iNKT cells in patients with NASH, which are positively correlated with the degree of liver inflammation, and therefore, they can be used as potential noninvasive indices for liver inflammation.
【关键字】:非酒精性脂肪性肝炎; 膜微粒; 诊断
【Key words】:nonalcoholic steatohepatitis; microparicles; diagnosis
【引证本文】:CHEN J, LI LP, FU WZ. Value of microparticles in the diagnosis of nonalcoholic steatohepatitis[J]. J Clin Hepatol, 2019, 35(9): 2026-2031. (in Chinese)
陈俊, 李良平, 付万智. 膜微粒在非酒精性脂肪性肝炎中的诊断价值[J]. 临床肝胆病杂志, 2019, 35(9): 2026-2031.

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