本文關(guān)鍵詞：非酒精性脂肪性肝病患者血清Chemerin水平的變化及其意義　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： Chemerin 危險(xiǎn)因素 非酒精性脂肪性肝病 胰島素抵抗

【摘要】：目的:探討非酒精性脂肪性肝病(NAFLD)患者血清Chemerin水平的變化及其意義。方法:選取2014年1月至2014年12月于河北省故城縣醫(yī)院內(nèi)科住院患者共72例(男性47例,女性25例),平均年齡59.41±9.08歲作為試驗(yàn)組。隨機(jī)取健康體檢人群102例(男性63例,女性39例),平均年齡61.07±6.73歲作為對(duì)照組。試驗(yàn)組應(yīng)符合以下入選標(biāo)準(zhǔn)(參照2010年中華醫(yī)學(xué)會(huì)肝病分會(huì)非酒精性脂肪性肝病診療指南):(1)無(wú)飲酒史或飲酒量140g/周(女性70g/周)。(2)腹部超聲學(xué)檢查符合彌漫性脂肪肝變的影像特征。(3)簽署知情同意。所有受試對(duì)象排除標(biāo)準(zhǔn):病毒性肝炎、藥物性肝炎、自身免疫性肝病、肝豆?fàn)詈俗冃�、全胃腸外營(yíng)養(yǎng)、甲狀腺功能亢進(jìn)或減退、惡性腫瘤、血液系統(tǒng)疾病、阻塞性睡眠呼吸暫停、嚴(yán)重的感染及心肺功能不全、多囊卵巢綜合癥(PCOS)、處于妊娠期、哺乳期及口服避孕藥女性、及可導(dǎo)致脂肪肝的其他疾病。根據(jù)血清Chemerin檢測(cè)值高低,將所有研究對(duì)象分為三個(gè)亞組,分別為較低水平組(65.14ng/ml)54例、中間水平組(65.14-79.29ng/ml)69例、較高水平組(79.29ng/ml)51例。腹部超聲影像學(xué)檢查用于篩選實(shí)驗(yàn)對(duì)象,反映肝臟脂肪浸潤(rùn)的類型,判斷脂肪肝的程度,提示是否存在顯性肝硬化。脂肪肝超聲影像學(xué)診斷標(biāo)準(zhǔn)(參照2010年中華醫(yī)學(xué)會(huì)肝病分會(huì)非酒精性脂肪性肝病診療指南):(1)肝區(qū)近場(chǎng)回聲彌漫性增強(qiáng),強(qiáng)于脾臟和腎臟,遠(yuǎn)場(chǎng)回聲逐漸衰減;(2)肝內(nèi)管道結(jié)構(gòu)顯示不清;(3)肝臟輕至中度腫大,邊緣圓鈍;(4)彩色多普勒血流顯像提示肝內(nèi)彩色血流信號(hào)減少或不易顯示,但肝內(nèi)血管走形正常;(5)肝右葉包膜及橫隔回聲顯示不清或不完整。依據(jù)腹部超聲影像學(xué)檢查結(jié)果,將實(shí)驗(yàn)組再分為三個(gè)亞組:輕度組、中度組、重度組。具備上述第1項(xiàng)及第2-4項(xiàng)中一項(xiàng)者為輕度脂肪肝(21例),具備上述第1項(xiàng)及第2-4項(xiàng)中兩項(xiàng)者為中度脂肪肝(27例),具備上述第1項(xiàng)以及第2-4項(xiàng)中兩項(xiàng)和第5項(xiàng)者為重度脂肪肝(24例)。調(diào)查并記錄所有研究對(duì)象性別、年齡、職業(yè)、既往史(心、腦、肝、腎等疾病)、家族史、吸煙史、用藥史、飲食習(xí)慣等。由專人測(cè)量身高、體重,計(jì)算體重指數(shù)bmi=體重(kg)/身高(m2),并測(cè)量血壓、心率,行全身體格檢查,必要時(shí)行腹部ct檢查。研究對(duì)象空腹12小時(shí)以上,于入院后第二日清晨采靜脈血,應(yīng)用我院瑞士羅氏cobas-8000全自動(dòng)生化分析儀測(cè)定空腹血糖(fbg)、空腹胰島素(fins)、糖化血紅蛋白(hbalc)、甘油三酯(tg)、總膽固醇(chol)、低密度脂蛋白膽固醇(ldl-c)、高密度脂蛋白膽固醇(hdl-c)、超敏c反應(yīng)蛋白(hs-crp)等生化指標(biāo)。計(jì)算胰島素抵抗指數(shù)(homa-ir)。另采靜脈血5ml,采用酶聯(lián)免疫吸附法檢測(cè)血清chemerin水平。應(yīng)用spss19.0版統(tǒng)計(jì)軟件對(duì)所有實(shí)驗(yàn)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,符合正態(tài)分布的計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差表示,計(jì)數(shù)資料以百分比表示,兩組間比較采用t檢驗(yàn),多組均數(shù)比較采用單因素方差分析(one-wayanova),計(jì)數(shù)資料采用χ2檢驗(yàn),雙變量采用pearson相關(guān)分析,相關(guān)程度分析采用logistic逐步回歸分析,以p0.05認(rèn)為有統(tǒng)計(jì)學(xué)差異。結(jié)果:1一般臨床資料比較試驗(yàn)組與對(duì)照組相比,在年齡、性別、高血壓患病率、吸煙史上無(wú)顯著性差異(p0.05)。而bmi試驗(yàn)組高于對(duì)照組(27.80±3.12kg/m2vs23.21±3.24kg/m2),差異有統(tǒng)計(jì)學(xué)意義(p0.05)。2血清chemerin檢測(cè)值水平的比較試驗(yàn)組血清chemerin檢測(cè)值水平高于對(duì)照組(81.02±13.11ng/mlvs62.21±12.32ng/ml),差異有統(tǒng)計(jì)學(xué)意義(p0.01)。3相關(guān)生化指標(biāo)比較與對(duì)照組相比,試驗(yàn)組的生化指標(biāo)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),均高于對(duì)照組(p0.05),而其hdl-c(1.41±0.26mmol/lvs1.73±0.37mmol/l)低于對(duì)照組(p0.05)。4不同chemerin檢測(cè)值水平的各亞組間比較較高水平組相比較低水平組,bmi、tg、homa-ir、hs-crp升高,差異有統(tǒng)計(jì)學(xué)意義(p0.05),HDL-C水平降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5 NAFLD組內(nèi)各亞組間比較重度脂肪肝組血清Chemerin水平、HOMA-IR、hs-CRP高于中度NAFLD組和輕度NAFLD組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。6血清Chemerin水平與各項(xiàng)指標(biāo)的相關(guān)性分析在試驗(yàn)組中,血清Chemerin的水平與BMI、TG、CHOL、LDL、FBG、HOMA-IR、hs-CRP呈正相關(guān)(r值為0.406、0.496、0.284、0.426、0.322、0.528,0.301 P均0.05),與HDL-C呈負(fù)相關(guān)(r=-0.376,P0.05)。7以是否發(fā)生非酒精性脂肪肝為因變量,以性別、年齡、是否患有高血壓、HOMA-IR、HAblc、TG、CHOL、LDL-C、HDL-C、hs-CPR、Chemerin為自變量,進(jìn)行Logistic逐步回歸分析,結(jié)果顯示,Chemerin是發(fā)生非酒精性脂肪性肝病的危險(xiǎn)因素(OR=2.071,P0.01)。校正年齡、性別、BMI、血糖、血脂、HOMA-IR,以Chemerin為自變量,以Chemerin最低分位低水平組為參照,行Logistic回歸分析,結(jié)果顯示中間水平組和高水平組OR值分別為2.835,4.933(P0.01)。結(jié)論:1非酒精性脂肪性肝病患者血清Chemerin呈高水平表達(dá)狀態(tài),且隨病情加重,血清Chemerin呈逐步增高趨勢(shì);2血清Chemerin檢測(cè)值水平與hs-CRP、HOMA-IR等生化指標(biāo)具有相關(guān)性;3較高水平的Chemerin可能是發(fā)生非酒精性脂肪性肝病的危險(xiǎn)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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R575.5

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