慢性丙型肝炎患者血清Pygo2水平对肝纤维化程度的评估价值探讨  

Serum Pygo2 levels as an indicator of liver fibrosis in patients with chronic hepatitis C

作　　者：朱传龙 朱甜甜 王坤 李文庭 李军[1] 李毓雯 Zhu Chuanlong Zhu Tiantian Wang Kung et al(Department of Infectious Diseases,First Affiliated Hospital, Nanjing Medical University ,Nanjing 210029 , Jiangsu Province,China)

机构地区：[1]南京医科大学第一附属医院感染病科,南京市210029 [2]安徽医科大学附属省立医院感染病科 [3]南京医科大学第一附属医院儿科,南京市210029

出　　处：《实用肝脏病杂志》2017年第2期161-164,共4页Journal of Practical Hepatology

基　　金：国家自然科学基金项目(编号:81271713);Gilead Sciences Research Scholars Programe in Liver Disease-Asia(国际项目)

摘　　要：目的探讨血清人尾肢同源蛋白(Pygo)水平诊断慢性丙型肝炎(CHC)患者肝纤维化的价值。方法本研究共入组90例慢性丙型肝炎患者,根据肝活检病理学检查肝纤维化程度,分为F0~F4组,采用ELISA法检测血清Pygo2水平。以肝活检病理检查结果为金标准绘制受试者工作特征曲线,并计算曲线下面积评估慢性丙型肝炎患者血清Pygo2水平对肝纤维化的诊断价值。结果在90例CHC患者中,经肝组织病理学检查,诊断F0、F1、F2、F3和F4分别为6例(6.7%)、13例(14.4%)、26例(28.9%)、35例(38.9%)和10(11.1%);F2组血清Pygo水平显著高于F1组[(70.1±19.8)ng/ml对(55.9±20.4)ng/ml,P<0.05],F3组[(100.1±24.6)ng/ml]显著高于F2组(P<0.001),F4组[(145.6±45.7)ng/ml]显著高于F3组(P<0.01);血清Pygo2水平与肝纤维化分期呈显著正相关(r=0.704,P<0.01);分别以血清Pygo2水平≥69.1 ng/m L、≥83.9 ng/m L和以≥109.60ng/m L为诊断显著肝纤维化、严重肝纤维化和肝硬化的截断点,其AUC值分别为0.8824、0.9004和0.8834,95%可信区间分别为0.806~0.959、0.836~0.964和0.768~0.999。结论在慢性丙型肝炎患者的各项检查指标中,血清Pygo2水平作为一种简单、有效的血清学指标,可有效评估患者肝纤维化程度。Objective To explore the reliability of serum people end limb homologous protein 2 （Pygo2） levels in diagnosis of liver fibrosis in patients with chronic hepatitis C （CHC）. Methods 90 patients with CHC were enrolled in this study, and they were divided into FO,F1,F2,F3 and F4 hepatic fibrosis according to liver fibrosis scores. Serum Pygo2 levels were tested by enzyme-linked immunosorbent assay,and the correlation between serum Pygo2 levels and liver fibrosis staging was performed. With liver biopsy as the gold standard of diagnosis,the ROC curves were delineated and the area under the curves（AUC） was calculated to evaluate the diagnostic efficacy for liver fibrosis. Results Out of 90 patients with CHC,the histopathological examination found F0 in 6 cases （6.7%）,F1 in 13 （14.4%）,F2 in 26（28.9%）,F3 in 35 （38.9%） and 174 in 10（11.1%）;Serum Pygo2 levels in 172 group was higher than that in F1 [（70.1 ± 19.8） ng/ml vs. （55.9 ± 20.4） ng/ml,P〈 0.05], serum Pygo2 levels [（100.1 ±24.6） ng/ml] in F3 was significantly higher than that in F2 （P〈0.001）,and serum Pygo2 levels in F4 [（145.6 ±45.7） ng/ml] was much higher than in F3 （P 〈0.01）;There were a statistically positive correlation between serum Pygo2 levels and hepatic fibrosis staging （r=0.704,P 〈 0.01）;assuming serum Pygo2 levels 〉169.1 ng/mL, 1〉83.9 ng/mL and ≥109.60ng/mL as the cut-off-value for diagnosis of obvious （F≥2） and severe liver fibrosis （F≥3） or liver cirrosis （F=4）,the AUC of ROC curves were 0.8824 （95% CI：0.806 ±0.959）,0.9004 （95% CI：0.836 ± 0.964） and 0.8834 （95% CI：0.768 ± 0.999）,respectively. Conclusion Serum Pygo2 level could be used to diagnose fiver fibrosis in patients with CHC, which warrants further study.

关 键 词：慢性丙型肝炎 肝纤维化 人尾肢同源蛋白 诊断 

分 类 号：R512.63[医药卫生—内科学] R575.2[医药卫生—临床医学]