血清CER、HA和FT3对慢性乙型肝炎肝纤维化的诊断价值  

Clinical significance of serum CER,HA and FT3 in diagnosis of liver fibrosis in chronic hepatitis B patients

作　　者：谭立明[1] 叶舒慧 华蕾 郭斌 赵永雷 张皓承 胡泽宇 曹梓超 吴洋[1] 曾婷婷[1] 田永建[1] 余建林[1] 李华[1] 陈娟娟[1] Tan Li-Ming;Ye Shu-Hui;Hua Lei;Guo Bin;Zhao Yong-Lei;Zhang Hao-Cheng;Hu Ze-Yu;Cao Zi-Chao;Wu Yang;Zeng Ting-Ting;Tian Yong-Jian;Yu Jian-Lin;Li Hua;Chen Juan-Juan(Department of Clinical Laboratory,Second Affiliated Hospital of Nanchang University,Jiangxi Key Laboratory of Laboratory Medicine,Nanchang 330006,China;School of Public Health,Nanchang University,Nanchang 330006,China;Wanzai County Maternal and Child Health Hospital,Yichun City,Jiangxi 336100,China;Second Clinical Medical College of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院检验科/江西省检验医学重点实验室,南昌330006 [2]南昌大学公共卫生学院,南昌330006 [3]宜春市万载县妇幼保健院,江西宜春336100 [4]南昌大学第二临床医学院,南昌330006

出　　处：《解放军医学杂志》2020年第6期646-650,共5页Medical Journal of Chinese People's Liberation Army

基　　金：江西省科技计划项目(20171BAB205076,20192BBG70033)。

摘　　要：目的探讨血清铜蓝蛋白(CER)、透明质酸(HA)和游离三碘甲腺原氨酸(FT3)评估慢性乙型肝炎(CHB)患者肝纤维化程度的临床应用价值。方法以南昌大学第二附属医院2014年7月-2018年1月确诊的136例CHB患者、44例乙型肝炎后肝硬化患者、20例HBsAg阳性原发性肝癌患者为研究对象,随机选取同期50例健康体检者为对照组。采用免疫散射比浊法检测患者血清CER,化学发光法检测HA和FT3,采用单因素方差分析或秩和检验比较各受试组与对照组的血清CER、HA、FT3及其他相关指标水平,对CER、HA、FT3与肝纤维化诊断模型进行相关性分析,并采用受试者特征曲线(ROC)分析结果。结果重度CHB组、失代偿期肝硬化组CER水平低于对照组,差异有统计学意义(P<0.05);重度CHB组、肝硬化组HA水平高于对照组,差异有统计学意义(P<0.05);肝硬化组、HCC组FT3水平低于对照组,差异有统计学意义(P<0.05)。Pearson相关性分析显示,CER与肝纤维化诊断模型(r=–0.202,P=0.004)和基于4因子的肝纤维化指标(r=–0.200,P=0.006)呈负相关,HA与二者呈正相关(r=0.491,P<0.001;r=0.514,P<0.001),FT3与二者呈负相关(r=-0.246,P=0.001;r=–0.361,P<0.000)。FT3、HA和CER诊断肝硬化的AUC分别为0.831、0.826和0.668,联合诊断的诊断效能从高到低依次为CER+HA+FT3、HA+FT3、CER+HA和CER+FT3。结论CHB患者血清CER、HA、FT3水平与其肝脏纤维化程度具有相关性,对诊断慢性乙型肝炎后肝硬化有重要的参考价值。Objective To investigate the clinical significance of serum ceruloplasmin(CER),hyaluronic acid(HA)and free thyroxine 3(FT3)in detecting liver fibrosis in patients with chronic hepatitis B(CHB).Methods One hundred and thirtysix cases of CHB patients,44 cases of post-CHB cirrhosis patients,20 cases with HBsAg-positive hepatocellular carcinoma(HCC),and 50 healthy controls were randomly selected from July 2014 to January 2018.Serum CER was detected by immune scattering turbidimetry,and direct chemiluminescence method was used for the detection of HA and FT3,one-way ANOVA analysis or rank sum test was used to compare the levels of serum CER,HA,FT3 and other related indexes between each group and the control group.Analysis of the correlation between CER,HA,FT3 and diagnosis model of liver fibrosis was performed and its results were analyzed using the receiver operating characteristic(ROC)curves.Results(1)The level of serum CER in severe CHB and decompensated liver cirrhosis group was significantly lower than that in control group(P<0.05).The concentration of HA in severe CHB and liver sclerosis groups was significantly higher than that in control group,and the difference was statistically significant(P<0.05).And the concentration of FT3 in cirrhotic group and HCC group was significantly different from that in control group(P<0.05).(2)CER was negatively correlated with APRI(r=–0.202,P=0.004)and FIB-4(r=–0.200,P=0.006),HA was positively correlated with APRI(r=0.491,P<0.000)and FIB-4(r=0.514,P<0.000),and FT3 was positively correlated with APRI(r=–0.246,P<0.001)and FIB-4(r=0.361,P<0.000).(3)The AUC(area under the curve)of FT3,HA and CER for the diagnosis of cirrhosis were 0.831,0.826 and 0.668,respectively.In order from high to low,the diagnostic efficacy of the groups was CER+HA+FT3,HA+FT3,CER+HA and CER+FT3.Conclusion The levels of serum CER,HA and FT3 in patients with CHB are correlated with the degree of liver fibrosis,and has an important reference value for diagnosis of post-CHB cirrhosis.

关 键 词：铜蓝蛋白 透明质酸 游离三碘甲腺原氨酸 慢性乙型肝炎 肝纤维化 

分 类 号：R446.6[医药卫生—诊断学]