The Diagnostic Value Of Serum CK18-M30,M65 Fragment And TNF- In Nonalcoholic Fatty Liver Disease

Objective The correlation between serum levels of cytokeratin 18-M30,cytokeratin18-M65 and tumor necrosis factor-level in patients with nonalcoholic fatty liver disease and NAS score of pathological results of liver biopsy was compared.To investigate the diagnostic value of serum levels of ck18-m30,CK18-M65 and TNF-? in nonalcoholic fatty liver disease(NAFLD)and their correlation with ALT,AST,?-GGT,TG,CHOL and bilirubin.Methods(1)A total of 86 patients with NAFLD confirmed by liver biopsy in the outpatient and in-patient department of infection diseases of Ningxia medical university general hospital from December 2016 to September 2019 were collected,including 64 males and 22 females.According to the NAS score ? 4,they were divided into the Nonalcoholic hepatic steatosis NAFL group,and the NAS score > 4 was divided into the Nonalcoholic steatohepatitis NASH group.There were 45 patients in NAFL group and 41 patients in NASH group.Among them,45 patients in the NAFL group were aged(37.71±11.01)years old,and 41 patients in the NASH group were aged(37.95±11.46)years old.Thirty patients with normal physical examination in the department of physical examination of our hospital during the same period were selected as the healthy control group,including 14 males and 16 females.(2)The serum levels of ck18-m30,ck18-m65 and TNF-were determined by double antibody one-step sandwich enzyme-linked immunosorbent assay.At the same time,biochemical routine detection and statistical analysis were performed on each patient.(3)Data analysis was performed usingSPSS20.0,The measurement data conforming to the normal distribution are expressed as mean ± standard deviation(? x±s).At the same time,the measurement data of normal distribution with homogeneous variances were measured.One-way analysis of variance test was used for comparison between groups,and LSD method was used for comparison between groups.The measurement data that did not conform to the normal distribution were represented by M(P25,P75).The comparison among groups was conducted by the non-parameter Kruskal-wallis test and paired comparison of multiple independent samples.Spearman correlation coefficient was used for correlation analysis of each index.The diagnostic value of serum ck18-m30,ck18-m65 and TNF-levels on NASH was analyzed by using the working characteristic curve of the subjects.At the same time,the optimal critical value(cut-off value)was calculated P <0.05 was considered statistically significant in all analyses.Results(1)There were statistically significant differences in gender composition and BMI between healthy control group,NAFL group and NASH group(P < 0.05),and no statistically significant differences in age among the three groups(P > 0.05).(2)CK18-M30,CK18-M65,and TNF-? suggesting statistically significant differences in the levels of the three cytokines in each group(P < 0.05).CK18-M30 and TNF-a levels were significantly different in the NAFL group and the control group,the NASH group and the control group,and the NASH group and the NAFL group(P < 0.05).The level of ck18-m65 was compared in two groups between the NASH group and the control group and between the NASH group and the NAFL group,and the difference was statistically significant(P < 0.05).The difference was not statistically significant between the NAFL group and the control group(P=0.304 > 0.05).(3)The levels of TBIL,AST,ALT,?-GGT,TG and CHOL in the three groups were statistically significant(P < 0.05).Paired comparisons revealed statistically significantdifferences in TBIL level between the control group and the NASH group(P < 0.05),but no statistically significant differences between the control group and the NAFL group,and the NAFL group and the NASH group(P > 0.05).AST,ALT,?-GGT,TG and CHOL levels were compared between the two groups,and the differences between the control group and the NAFL group and the control group and the NASH group were statistically significant(P <0.05),while the differences between the NAFL group and the NASH group were not statistically significant(P=1 > 0.05).(4)Serum CK18-M30 fragment level was positively correlated with transaminase,bilirubin and blood lipid(r >,P < 0.05),TNF-? level was positively correlated with bilirubin,transaminase and total cholesterol(r > 0,P < 0.05),but not with TG(P=0.360 >0.05).There was no correlation between ck18-m65 fragment level and bilirubin,transaminase and blood lipid.NAS scores were positively correlated with serum CK18-M30 and CK18-M65 levels(r > 0,P < 0.05),but not with TNF-?(P > 0.05).(5)The areas under the curve of serum CK18-M30,CK18-M65,and TNF-? were 0.824,0.863 and 0.675,respectively.The optimal critical values for diagnosis of NASH were661.5ng/mL,823.5pg/mL and 79.76pg/mL,respectively.The sensitivity was 78%,92.7%and 70.7%,and the specificity was 80%,68.9% and 57.8%,respectively.The area under the ROC curve was 0.934 when the three cytokines were combined.Therefore,serum levels of ck18-m30,ck18-m65 and TNF-? are of good diagnostic value for NASH patients,and the combined diagnosis of the three is more effective.Conclusion(1)Serum levels of CK18-M30 and TNF-? are closely related to liver injury.Ck18-m65 is lower in the early stage of NAFLD,but it may better reflect the degree of liver injury in NASH stage than ck18-m30 and TNF-?.(2)Serum CK18-M30,CK18-M65 and TNF-? scan have certain value in diagnosing NASH,and their value is higher in combination.