Wang Qingling, Zhu Mingyu, Li Hu, Chen Peizhan, Wang Mingjie, Gu Leilei, Zhang Xinxin, Chen Li
The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People's Republic of China.
Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Diabetes Metab Syndr Obes. 2022 May 17;15:1543-1552. doi: 10.2147/DMSO.S361187. eCollection 2022.
Elevated serum ferritin (SF), also defined as hyperferritinemia, is commonly seen in patients with nonalcoholic fatty liver disease (NAFLD). However, the clinical significance of SF in NAFLD remains controversial. The aim of this study was to characterize the NAFLD patients with elevated SF and to explore the association of hyperferritinemia with the severity of NAFLD proved by liver biopsy in the Chinese population.
A total of 136 NAFLD patients proved by liver biopsy were enrolled. The demographic, anthropometric, clinical historic, laboratory, and histological characteristics were compared between elevated and normal SF groups. The independent factors for elevated SF were determined using multivariate logistic regression analysis.
The median age and body mass index were 41.00 (33.00-57.75) years and 28.28 (26.28-31.34) kg/m, respectively. Hyperferritinemia was detected in 57 (41.9%) patients. Patients in the elevated SF group presented with more severe lipo- and glucometabolic disorder, and higher aminotransferases compared to those in the normal SF group (p < 0.05). In terms of histopathology, elevated SF was associated with worse steatosis and a higher proportion of positive iron staining (p < 0.05). Multivariate logistic regression analysis identified homeostasis model assessment of insulin resistance (OR: 1.170, 95% CI: 1.036-1.322, p = 0.012), alanine aminotransferase (OR: 1.012, 95% CI: 1.005-1.019, p < 0.001), and positive Perl's staining (OR: 4.880, 95% CI: 2.072-11.494, p < 0.001) as independent risk factors of hyperferritinemia.
NAFLD patients with hyperferritinemia were characterized as more severe metabolic dysfunction and liver injury. More attention should be paid to the metabolism state of NAFLD patients with elevated SF. Hyperferritinemia was correlated to hepatic steatosis in Chinese NAFLD patients.
血清铁蛋白（SF）升高，也被定义为高铁蛋白血症，在非酒精性脂肪性肝病（NAFLD）患者中很常见。然而，SF在NAFLD中的临床意义仍存在争议。本研究的目的是对SF升高的NAFLD患者进行特征描述，并探讨在中国人群中，经肝活检证实的高铁蛋白血症与NAFLD严重程度之间的关联。
共纳入136例经肝活检证实的NAFLD患者。比较SF升高组和正常组之间的人口统计学、人体测量学、临床病史、实验室检查和组织学特征。使用多因素逻辑回归分析确定SF升高的独立因素。
中位年龄和体重指数分别为41.00（33.00 - 57.75）岁和28.28（26.28 - 31.34）kg/m²。57例（41.9%）患者检测到高铁蛋白血症。与正常SF组相比，SF升高组患者存在更严重的脂肪和糖代谢紊乱，转氨酶水平更高（p < 0.05）。在组织病理学方面，SF升高与更严重的脂肪变性和更高比例的铁染色阳性相关（p < 0.05）。多因素逻辑回归分析确定胰岛素抵抗的稳态模型评估（OR：1.170，95%CI：1.036 - 1.322，p = 0.012）、丙氨酸转氨酶（OR：1.012，95%CI：1.005 - 1.019，p < 0.001）和Perl染色阳性（OR：4.880，95%CI：2.072 - 11.494，p < 0.001）为高铁蛋白血症的独立危险因素。
高铁蛋白血症的NAFLD患者具有更严重的代谢功能障碍和肝损伤特征。应更多关注SF升高的NAFLD患者的代谢状态。在中国NAFLD患者中，高铁蛋白血症与肝脂肪变性相关。
