血清同型半胱氨酸水平与非酒精性脂肪性肝病组织学严重程度的相关性。

Association of Serum Homocysteine Levels with Histological Severity of NAFLD.

机构信息

Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China. .

Wenzhou Medical University, Faculty of Nursing, Wenzhou 325000, Zhejiang, China.

出版信息

J Gastrointestin Liver Dis. 2020 Mar 13;29(1):51-58. doi: 10.15403/jgld-529.

DOI:10.15403/jgld-529

PMID:32176759

Abstract

BACKGROUND AND AIMS

Studies on the association between homocysteine and non-alcoholic fatty liver disease (NAFLD) have shown inconsistent results. Our study concerns the association of homocysteine with the histological severity of NAFLD, especially non-alcoholic steatohepatitis (NASH) and significant fibrosis (SF) after adjusting for other well-identified risk factors.

METHODS

This study enrolled 289 patients with biopsy proven NAFLD. The association of homocysteine with the severe histological features was examined using multivariable logistic regression analysis and subgroup analysis. The area under curves (AUC) and Hosmer-Lemeshow goodness-of-fit test for the adjusted logistic regression models was analyzed.

RESULTS

After multivariable regression analysis, homocysteine showed significant correlation with NASH (OR 0.79 95%CI: 0.69-0.89), p<0.001) and SF (OR 0.83 95%CI: 0.72-0.95, p=0.009). Spearman's correlation analysis showed homocysteine levels were inversely correlated with the grade of hepatocellular ballooning and the stage of liver fibrosis (Spearman's ρ=-0.13, p=0.033; Spearman's ρ=-0.16, p=0.007), but had no correlation with the severity of steatosis and lobular inflammation. The subgroup analyses showed that homocysteine was strongly associated with NASH in females but was weaker in males (female OR: 0.61 95%CI: 0.45-0.84; male 0.86 95%CI: 0.75-0.99), and on SF showed no significant differences in the subgroups. The models showed good discrimination for NASH (AUC 0.789, 95% CI: 0.736-0.843) and for SF (0.784 95%CI: 0.719-0.848) and calibration (Hosmer-Lemeshow goodness-of-fit test, p=0.346 for NASH; p=0.908 for SF).

CONCLUSION

Elevated serum homocysteine levels are negatively associated with NASH and SF in subjects with NAFLD.

摘要

背景与目的

关于同型半胱氨酸与非酒精性脂肪性肝病（NAFLD）之间的相关性的研究结果并不一致。我们的研究关注同型半胱氨酸与 NAFLD 组织学严重程度的相关性，尤其是在调整其他公认的危险因素后，与非酒精性脂肪性肝炎（NASH）和显著纤维化（SF）的相关性。

方法

本研究纳入了 289 例经活检证实的 NAFLD 患者。使用多变量逻辑回归分析和亚组分析来检查同型半胱氨酸与严重组织学特征的相关性。分析调整后的逻辑回归模型的曲线下面积（AUC）和 Hosmer-Lemeshow 拟合优度检验。

结果

多变量回归分析后，同型半胱氨酸与 NASH（比值比 0.79，95%可信区间：0.69-0.89）和 SF（比值比 0.83，95%可信区间：0.72-0.95，p=0.009）呈显著相关性。Spearman 相关性分析显示，同型半胱氨酸水平与肝细胞气球样变的严重程度和肝纤维化分期呈负相关（Spearman ρ=-0.13，p=0.033；Spearman ρ=-0.16，p=0.007），但与脂肪变性和肝小叶炎症的严重程度无相关性。亚组分析显示，同型半胱氨酸与女性的 NASH 关系密切，但在男性中较弱（女性比值比：0.61，95%可信区间：0.45-0.84；男性 0.86，95%可信区间：0.75-0.99），而在 SF 亚组中无显著差异。模型对 NASH（AUC 0.789，95%可信区间：0.736-0.843）和 SF（0.784，95%可信区间：0.719-0.848）具有良好的判别能力，且校准效果良好（Hosmer-Lemeshow 拟合优度检验，NASH 为 p=0.346；SF 为 p=0.908）。