慢性乙肝不同炎症分级患者的肝功能、纤维化指标和GP73检测及临床意义  

Detection of hepatic function, fibrosis index and expression of GP73 in chronic hepatitis B patients with different inflammation grades

作　　者：姜娜 李瑛 王光东 魏鑫 JIANG Na;LI Ying;WANG Guang-dong;WEI Xin(Department of Hepatology,Xi'an Eighth Hospital,Xi'an 710061,Shaanxi,CHINA)

机构地区：[1]西安市第八医院肝病科

出　　处：《海南医学》2019年第24期3155-3158,共4页Hainan Medical Journal

摘　　要：目的分析慢性乙肝不同炎症分级患者的肝功能、纤维化指标检测及高尔基蛋白73(GP73)表达情况,探究其检测价值,为临床诊断及预后判断提供参考依据。方法选择2016年2月至2019年5月在西安市第八医院治疗的慢性乙肝患者94例为研究对象。常规进行肝组织活检,根据检测结果按照不同炎症分级将患者分为轻度炎症组(G0~G1级)及中重度炎症组(G2~G3级),每组47例。检测分析两组患者血清胆汁酸(TBA)、甲胎蛋白(AFP)、总胆红素(TBil)、碱性磷酸酶(ALP)、丙氨酸转氨酶(ALT)、白蛋白(ALB)、纤维化指标[Ⅲ型前胶原N端肽(PⅢNP)、Ⅳ型胶原蛋白(Ⅳ-C)、透明质酸(HA)、层黏连蛋白(LN)]及GP73水平,并分析GP73对肝纤维化的诊断价值。结果轻度炎症组患者的血清TBA、AFP、TBil、ALP、ALT水平分别为(13.72±3.07)μmol/L、(16.47±3.48)ng/mL、(20.47±2.85)μmol/L、(159.58±8.53)U/L、(69.83±5.82)U/L,明显低于中重度炎症组的(34.56±7.45)μmol/L、(22.38±5.76)ng/mL、(29.45±4.81)μmol/L、(187.42±12.24)U/L、(89.16±8.94)U/L,而ALB为(56.37±4.48)g/L,明显高于中重度炎症组的(38.62±2.21)g/L,差异均有统计学意义(P<0.05);轻度炎症组患者的PⅢNP、Ⅳ-C、HA、LN水平分别为(36.71±6.48)ng/mL、(104.32±5.08)ng/mL、(113.35±15.56)ng/mL、(134.83±14.54)ng/mL,明显低于中重度炎症组的(71.45±6.96)ng/mL、(129.46±5.82)ng/mL、(147.12±17.68)ng/mL、(160.64±15.79)ng/mL,差异均有统计学意义(P<0.05);轻度炎症组患者GP73表达水平为(76.71±14.58)ng/mL,明显低于中重度炎症组的(161.96±21.47)ng/mL,差异有统计学意义(P<0.05);血清GP73浓度与纤维化分级呈正相关性(r=0.32,P<0.05);血清GP73诊断纤维化(≥S2)的敏感性为62.50%,特异性为80.00%,血清GP73诊断炎症(≥G2)敏感性为53.20%,特异性为80.21%。结论慢性乙肝患者随着其炎症反应加重,肝功能指标、纤维化指标及GP73蛋白的表达水平也随之增长;加强患者肝功能、纤维化Objective To analyze the liver function,fibrosis index and expression of Golgi protein 73(GP73)in chronic hepatitis B patients with different inflammation grades,and to explore its detection value,so as to provide reference for clinical diagnosis and prognosis judgment.Methods Ninety-four patients with chronic hepatitis B treated in Xi'an Eighth Hospital from February 2016 to May 2019 were selected and divided into the mild inflammation group(G0-G1 grade),moderate and severe inflammation group(G2-G3 grade)according to the results of routine liver biopsy,with 47 cases each group.The liver function indexes including serum bile acid(TBA),alpha fetoprotein(AFP),total bilirubin(TBIL),alkaline phosphatase(ALP),alanine transaminase(ALT),albumin(ALB),fibrosis indexes(typeⅢprocollagen N-terminal peptide[PⅢNP],typeⅣcollagen[Ⅳ-C],hyaluronic acid[HA],laminin[LN])and serum GP73(Immunohistochemistry)were detected and analyzed,and the diagnostic value of GP73 in liver fibrosis was analyzed.Results The levels of TBA,AFP,TBil,ALP and ALT in the mild inflammation group were(13.72±3.07)μmol/L,(16.47±3.48)ng/mL,(20.47±2.85)μmol/L,(159.58±8.53)U/L,(69.83±5.83)U/L,respectively,which were significantly lower than corresponding(34.56±7.45)μmol/L,(22.38±5.76)ng/mL,(29.45±4.81)μmol/L,(187.42±12.24)IU/L,(89.16±8.94)U/L in the moderate and severe inflammation group,but the level of ALB in the mild inflammatory group was(56.37±4.48)g/L,which was significantly higher than(38.62±2.21)g/L in the moderate and severe inflammation group(all P<0.05);the levels of PⅢNP,Ⅳ-C,HA and LN in the mild inflammation group were(36.71±6.48)ng/mL,(104.32±5.08)ng/mL,(113.35±15.56)ng/mL,(134.83±14.54)ng/mL,respectively,which were significantly lower than corresponding(71.45±6.96)ng/mL,(129.46±5.82)ng/mL,(147.12±17.68)ng/mL,(160.64±15.79)ng/mL in the moderate and severe inflammation group(all P<0.05);the level of GP73 in the mild inflammation group was(76.71±14.58)ng/mL,which was significantly lower than(161.96±21.47)ng/mL in

关 键 词：慢性乙型肝炎 肝功能指标 纤维化标志物 高尔基蛋白73 肝活检 监测 

分 类 号：R512.62[医药卫生—内科学]