细胞角蛋白-18联合受控衰减参数二步法无创鉴别非酒精性脂肪性肝炎的临床研究  

Value of a two-step approach with cytokeratin-18 and controlled attenuation parameter in noninvasive differential diagnosis of nonalcoholic steatohepatitis

作　　者：沈峰[1] 郑瑞丹 宓余强[3] 施军平[4] 王晓颖[5] 胡锡琪[6] 潘勤[1] 徐雷鸣[1] 范建高[1] 

机构地区：[1]上海交通大学医学院附属新华医院消化内科,200092 [2]福建省漳州市正兴医院,363000 [3]天津市第二人民医院,300150 [4]杭州师范大学附属医院,311121 [5]上海交通大学医学院附属新华医院病理科,200092 [6]上海市复旦大学医学院病理教研室,200032

出　　处：《中华肝脏病杂志》2016年第6期429-434,共6页Chinese Journal of Hepatology

基　　金：国家重点基础研究发展计划项目（2012CB517501）;中国肝炎防治基金会王宝恩肝纤维化研究基金（XJS20120501）;苏州市科技发展计划基金资助项目（SYSD2013059,ZXY2013003）

摘　　要：目的 评价细胞角蛋白-18（CK-18）联合受控衰减参数（CAP）二步法无创诊断非酒精性脂肪性肝炎（NASH）的价值.方法 纳入经“肝活组织检查”证实的非酒精性脂肪性肝病65例,其中NASH 30例.CK-18采用M30及M65定量检测酶联免疫吸附（ELISA）试剂盒.FibroScan完成CAP测定.绘制受试者工作特征（ROC）曲线及曲线下面积（AUROC）来判定无创诊断价值.联合诊断采用二分类logistic模型计算预测概率.采用最大Youden指数、敏感度＞90％及特异度＞90％分别确定最佳临界值、低值及高值. 结果 多因素分析提示,M65 （OR 1.004,95％CI1.002 ～ 1.007,P=0.003）及CAP （OR 1.017,95％CI 1.001 ～ 1.033,P=0.036）是NASH的独立预测因素.M65＋CAP组合的AUROC （95％CI）为0.851 （0.761 ～ 0.942）,高于M65的0.808（0.702 ～ 0.913）及CAP的0.677 （0.545 ～ 0.808）.M65采用高值（820.8 U/L）及低值（527.7U/L）,CAP采用最佳临界值（293.5 dB/m）,进行二步法鉴别NASH,阳性预测值为85.7％,阴性预测值为100％,符合率为92.0％. 结论 M65联合CAP二步法可以提高NASH的无创诊断价值,较高的阴性预测值可以避免不必要的肝活组织检查.Objective To investigate the value of a two-step approach with cytokeratin-18 （CK-18） and controlled attenuation parameter （CAP） in the noninvasive diagnosis of nonalcoholic steatohepatitis （NASH）.Methods A total of 65 patients with biopsy-proven nonalcoholic fatty fiver disease were enrolled,including 30 patients with NASH.The M30 and M65 enzyme-linked immunosorbent assay kits were used to measure serum CK-18,and FibroScan was used to measure CAP.The receiver operating characteristic （ROC） curve was plotted,and the area under the ROC curve （AUROC） was used to determine the value of noninvasive diagnosis.The binary logistic regression model was used to calculate the predicted probability of combined diagnosis.The maximum Youden index,a sensitivity of ＞90％,and a specificity of ＞ 90％ were used to determine the optimal cut-off value,the low value,and the high value,respectively.Results The results of the multivariate analysis showed that M65 （OR =1.004,95％ CI1.002-1.007,P =0.003） and CAP （OR =1.017,95％ CI 1.001-1.033,P =0.036） were independent predictors of NASH.The AUROC of M65＋CAP was 0.851 （95％ CI 0.761-0.942）,higher than 0.808（95％ CI 0.702-0.913） of M65 and 0.677 （95％ CI 0.545-0.808） of CAP alone.A two-step approach with high （820.8 U/L） and low （527.7 U/L） values for M65 and the optimal cut-offvalue （293.5 dB/m） for CAP was used for the differential diagnosis of NASH,with a positive predictive value of 85.7％,a negative predictive value of 100％,and a coincidence rate of 92.0％.Conclusion A two-step approach with M65 and CAP can improve the value of noninvasive diagnosis of NASH,and a high negative predictive value can avoid unnecessary liver biopsy.

关 键 词：肝炎 脂肪性 非酒精性 受控衰减参数 细胞角蛋白-18 无创诊断 

分 类 号：R575.5[医药卫生—消化系统]