脂蛋白相关磷脂酶A2与乙肝肝硬化Child-Pugh分级  

Relationship between Lp-PLA2 and Child-Pugh classification in patients with hepatitis B cirrhosis

作　　者：邢继成 何玉杰[1] 李平[2] 朱月蓉[1] 楼小伟[1] 顾畅[1] 邱红[1] Ji-Cheng Xing;Yu-Jie He;Ping Li;Yue-Rong Zhu;Xiao-Wei Lou;Chang Gu;Hong Qiu(Department of Clinical Laboratory,Bayi Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing 210002,Jiangsu Province,China;Liver Disease Center,Bayi Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing 210002,Jiangsu Province,China)

机构地区：[1]南京中医药大学附属八一医院检验科,江苏省南京市210002 [2]南京中医药大学附属八一医院肝病中心,江苏省南京市210002

出　　处：《世界华人消化杂志》2019年第3期160-166,共7页World Chinese Journal of Digestology

摘　　要：目的探讨血清脂蛋白相关磷脂酶A2(lipoprotein related phospholipase A2,Lp-PLA2)水平与乙型肝炎肝硬化Child-Pugh分级的关系.方法选择269例乙型肝炎肝硬化患者为病例组,慢性乙型肝炎(chronic hepatitis B, CHB)组157例为疾病对照组,健康体检者120例为正常组,肝硬化患者根据ChildPugh分级分为A、B、C组进行,各组均抽取静脉血采用免疫散射比浊法检测其血清Lp-PLA2水平,采用倾向性评分匹配统计学分析进行筛选,根据匹配结果对应的分组进行统计分析,比较各组间的差异.结果肝硬化C组血清Lp-PLA2水平(443.1 ng/mL±40.6ng/mL)明显高于肝硬化A组(208.5ng/mL±84.6ng/mL)、B组(390.5 ng/mL±42.3 ng/mL)和CHB组(154.3ng/mL±54.1ng/mL)(P <0.01),肝硬化B组明显高于肝硬化A组和CHB组(P<0.01),肝硬化A组明显高于CHB组(P <0.01),CHB组与健康对照组(119.1ng/mL±19.8 ng/mL)相比差异显著(P<0.01); ROC曲线显示:当对照组设为CHB对肝硬化的AUC为0.852,诊断阈值为262.5 ng/mL;对照组设为硬化A级对肝硬化B级的AUC为0.969,诊断阈值为311.5 ng/mL;对照组设为硬化B级对24例肝硬化C级的AUC为0.809,诊断阈值为420.5 ng/mL.结论血清Lp-PLA2水平随乙型肝炎肝硬化的病程进展呈升高趋势,有助于肝硬化Child-Pugh分级的判断,血清Lp-PLA2水平的变化可作为乙型肝炎肝硬化病程监测的参考指标.AIM To investigate the association between serum lipoprotein related phospholipase A2(Lp-PLA2)level and Child-Pugh classification in patients with hepatitis B cirrhosis.METHODS A total of 269 patients with hepatitis B cirrhosis were selected as a case group,157 patients with chronic hepatitis B selected as a disease control group,and 120 healthy subjects as a normal control group.Cirrhotic patients were divided into groups A,B,and C according to Child-Pugh classification.The venous blood was collected from each group and serum Lp-PLA2 level was detected by immunoturbidimetry.After propensity score matching(PSM),statistical analysis was performed to compare serum Lp-PLA2 levels between different groups.RESULTS The level of serum Lp-PLA2 was significantly higher in the liver cirrhosis group C(443.1 ng/mL±40.6 ng/mL)than in the liver cirrhosis groups A(208.5 ng/mL±84.6 ng/mL)and B(390.5 ng/mL±42.3 ng/mL)and the chronic hepatitis B group(154.3 ng/mL±54.1 ng/mL)(P<0.01),in the liver cirrhosis group B than in the liver cirrhosis group A and the chronic hepatitis B group(P<0.01),and in the liver cirrhosis group A than in the liver chronic hepatitis B group(P<0.01).Similar results were also found between the chronic hepatitis B group and the healthy control group(119.1 ng/mL±19.8 ng/mL)(P<0.01).The ROC curve showed that when chronic hepatitis B was used as the control group,the area under the ROC curve of liver cirrhosis was 0.852,and the diagnostic threshold was 262.5 ng/mL.When cirrhosis grade A was used as the control group,the area under the ROC curve of cirrhosis grade B was 0.969,and the diagnostic threshold was 311.5 ng/mL.When cirrhosis grade B was used as the control group,the area under the ROC curve of cirrhosis grade C was 0.809,and the diagnostic threshold was 420.5 ng/mL.CONCLUSION The level of serum Lp-PLA2 increases with the progression of hepatitis B cirrhosis,which is helpful for judging the Child-Pugh classification of patients with hepatitis B cirrhosis.Serum Lp-PLA2 level can be used as a refere

关 键 词：脂蛋白相关磷脂酶A2 乙肝肝硬化 慢性乙型肝炎 缺氧 CHILD-PUGH分级 

分 类 号：R575.2[医药卫生—消化系统]