| Objective:To Discuss the Clinical significance of the blood CK-18 fragments and inflammation ralated factors level in NAFLD with MS, and to provide the theory basis for preventing NAFLD with MS from progressing to Severe liver disease.Methods:1. We enrolled a total of 85 cases of NAFLD paitents in Sichuan Provincial People's hospital from October 2008 to December 2009. (By the diagnostic and treatment guidelines of NAFLD of China,2006).2. All subjects underwent physical examination, anthropometric measurements and biochemical screening. Liver ultrasound (US) scanning was performed to assess the degree of steatosis, OGTT,glycated hemoglobin,and so on. Blood samples were centrifuged at 2500 g for 10 min, and serum aliquots were stored at-70℃until immediately before analysis. and recruited normal control groups 20 cases in all.3. All subjects were divided into two groups according to whether with the metabolic syndrome they were or not and how many the components of MS they had①MS+NAFLD,NAFLD,NC②MS1,MS2and MS3 depended on how many components of MS they contained.4. Serum levels of cytokeratin-18 fragments (M30-antigen) and total cytokeratin-18 (M65-antigen) and inflammation ralated factors (TNF-α,IL-6) were determined by ELISA., Serum levels of hs-CRP was tested by laboratory of Sichuan Provincial 'People's hospital by Rate of scattering method.Results:1. There was a statistical significance of CK-18 fragment serum level in MS+NAFLD comparing to NAFLD,NC groups Respectively.(F=4.251,p<0.05).2. There was a statistical significance of serum CK-18 fragment in MS3 to MS1,MS2 groups (F=3.776,P<0.05),however, there was not statistical significance between MS1and MS2 groups (P>0.05)3. There were a statistical significance of plasma PBG(2h),INS(2H) level amog MS+NAFLD,NAFLD and NC groups (F=31.18,F=25.91;P<0.05 Respectively), and There were statistical significance about HOMA-IR and INS of MS+NAFLD comparing to NAFLD and NC groups (F=9.24,p<0.05;F=25.54,P<0.05) Respectively.4. serum alpha-TNF level in MS+NAFLD,NALFD groups were higher than NC group(F=6.994,p<0.05),but there was no statistical significance among MS3,MS2 and MS1groups (F=0.375,0.688)5. among MS+NAFLD,NALFD and NC groups,There was a statistical significance of plasma(H=31.764,P<0.05) hs-CRP level,but there was no statistical significance among MS3,MS2 and MS1 groups (H=0.68,0.712)6. serum IL-6 level in MS+NAFLD is higher than NAFLD,NC groups, and MS3 group has statistical significance comparing to MS2,MS1 groups Respectively.7. There were obvious statistical significance of plasma ALT,GGT level among MS+NAFLD,NALFD and NC groups (F=55.22,P<0.05;F=22.56,P<0.05),and they had a statistical significance in MS3 comparing to MS1 groups Respectively. (F=14.027, P<0.05;F=6.18,P<0.05).Conclusion: 1. The apoptosis of hepatocyte,inflammation,Insulin resistance degree in MS+NAFLD was more obvious than NAFLD and NC.2. when the components of MS is more than three,the Inflammatory reaction,apoptosis of hepatocyte and Insulin resistance were more obvious than which is blow three components of MS and NAFLD,NC.3. The high expression of hepatocyte apoptosis biomarker CK-18 fragment and inflammation related factors indicated that MS+NAFLD may have the tendence to progress to NASH.so that MS+NAFLD patients could be given early Monitoring and prevention before Severe liver disease.
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