γ-谷氨酰转肽酶与血小板比值评估慢性HCV感染者以及HCV/HIV合并感染者肝纤维化的临床应用价值  

Clinical value of gamma-glutamyltranspeptidase to platelet ratio index(GPRI)in the evaluation of liver fibrosis caused by chronic HCV-infection and HCV/HIV-coinfection

作　　者：杨英祥 吕琳婷 李渊韬 许强 屠静 沈弢 YANG Ying-xiang;LU Lin-ting;LI Yuan-tao;XU Qiang;TU Jing;SHEN Tao(Department of Hepatobiliary Surgery,The Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第六医学中心肝胆外科,北京100048 [2]北京大学医学部病原生物学系及感染病研究中心,北京100191

出　　处：《中国病毒病杂志》2020年第4期255-262,共8页Chinese Journal of Viral Diseases

基　　金：国家自然科学基金面上项目(81271826)。

摘　　要：目的探讨γ-谷氨酰转肽酶与血小板比值(GPRI)在评估丙型肝炎病毒(hepatitis C virus,HCV)单感染以及HCV/人类免疫缺陷病毒(human immunodeficiency virus,HIV)合并感染者肝纤维化的潜在临床应用价值。方法2009年在河南省上蔡县王营村共发现HCV慢性单感染者(HCV组)114人,HCV/HIV合并感染者(HCV/HIV组)98人,选取健康对照组(HCs组)61人。2017年随访中剔除死亡35人、失访72人以及接受HCV治疗者11人后,成功随访HCV组68人,HCV/HIV组50人以及HCs组37人。两次调查均进行了HCV/HIV相关病毒学检测、血常规和肝功能分析,2017年随访增加了FibroTouch肝硬度分析。结果2009年和2017年HCV组[2009年:0.192(0.144~0.366),2017年:0.313(0.172~0.640)]和HCV/HIV组[2009年:0.554(0.286~1.129),2017年:0.603(0.400~1.341)]GPRI均显著高于HCs组[2009年:0.126(0.096~0.188),2017年:0.153(0.118~0.291)],HCV/HIV组GPRI高于HCV组。与2009年比较,2017年HCV组[0.313(0.172~0.640)vs 0.198(0.146~0.283),P<0.001]和HCV/HIV组[0.603(0.400~1.341)vs 0.473(0.305~1.030),P=0.004]GPRI均显著升高。比较2017年生存者和2009-2017年由于终末期肝病已去世者在2009年的GPRI值,后者2009年的GPRI显著高于前者[HCV组:0.452(0.227~1.281)vs 0.192(0.143~0.313),P=0.024;HCV/HIV组:1.554(1.054~4.340)vs 0.473(0.265~1.051),P<0.001]。2017年HCV组和HCV/HIV组的GPRI和FibroTouch肝硬度指数均呈明显正相关。进一步比较2017年丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)正常者的GPRI,发现HCV/HIV组仍然显著高于HCV组[0.546(0.379~0.964)vs 0.200(0.136~0.964),P<0.001]。GPRI和FibroTouch肝硬度指数之间的正相关只见于HCV组转氨酶正常者,并未出现在HCV/HIV合并感染组的转氨酶正常者。结论GPRI对评估HCV单感染和HCV/HIV合并感染者肝纤维化状态可能有较好的临床应用价值,但对于转氨酶正常人群,只有HCV单感染者的GPRI与肝硬度之间存在一定的正向相关性。Objective To evaluate the clinical value ofγ-glutamyl-transpeptidase to platelet ratio index(GPRI)in the evaluation of liver fibrosis caused by chronic HCV-infection and HCV/HIV-coinfection.Methods A total of 273 individuals were investigated in 2009 in Wangying village of Shangcai county,Henan province of China,including chronic HCV-infected individuals(HCV group,n=114),HCV/HIV-coinfected individuals(HCV/HIV group,n=98)and healthy controls(HCs group,n=61).In a follow-up survey in 2017,after exclusion of 35 died individuals,11 received HCV-specific treatment and 72 lost in follow-up,68 chronic HCVinfected individuals,50 HCV/HIV-coinfected individuals and 37 healthy controls were successfully visited.In the primary and follow-up surveys,all individuals were received HCV-and HIV-associated virological detection,complete blood count(CBC)analysis and liver function tests promptly after collection of venous blood samples.Specifically,FibroTouch liver stiff analysis was included in 2017 survey.Results Both results in2009 and 2017 indicated that the GPRI values in HCV[2009:0.912(0.144~0.366),2017:0.313(0.712~0.640)]and HCV/HIV groups[2009:0.554(0.286~1.129),2017:0.603(0.400~1.341)]were higher than that in healthy controls[2009:0.126(0.096~0.188);2017:0.153(0.118~0.291)],and GPRI values in the HCV/HIV group were higher than that in the HCV group.GPRI values in both HCV[0.313(0.172~0.640)]and HCV/HIV[0.603(0.400~1.341)]groups in 2017 were longitudinally increased than that in 2009[HCV:0.198(0.146~0.283);HCV/HIV:0.473(0.305~1.030)].Importantly,comparing to survivors in 2017,the dead persons during 2009 to 2017[HCV:0.452(0.227~1.281);HCV/HIV:1.554(1.054~4.340)]showed higher GPRI values in 2009[HCV:0.192(0.143~0.313);HCV/HIV:0.473(0.265~1.051)].Further analysis indicated that GPRI values in 2017 were positively correlated with FibroTouch liver stiffness indexes for both HCV group(P<0.001)and HCV/HIV group(P=0.022).Finally,in 2017 survey,among patients with normal serum transaminase levels,the GPRI values in the HCV/HIV grou

关 键 词：γ-谷氨酰转肽酶与血小板比值(GPRI) HCV HIV 丙氨酸转氨酶(ALT) 天冬氨酸转氨酶(AST) 肝硬度 

分 类 号：R512.63[医药卫生—内科学]