血浆GP73联合肝脏硬度检测诊断乙型和丙型肝炎患者肝纤维化临床价值分析  

Diagnostic values of plasma Golgi protein 73 and liver stiffness measurement combination for liver fibrosis in patients with hepatitis B and C

作　　者：崔璐瑶 苑喜微 刘领弟[1] 张莹[1] 赵文[1] 赵丹丹[1] 杨杨 南月敏[1] Cui Luyao;Yuan Xiwei;Liu Lingdi(Department of Traditional and Western Intervention on Liver Diseases,Hebei Key Laboratory of Liver Fibrosis Study,Third Hospital,Hebei Medical University,Shijiazhuang 050051,Hebei Province,China)

机构地区：[1]河北医科大学第三医院中西医结合肝病科/河北省慢性肝病肝纤维化机制研究重点实验室,石家庄市050000

出　　处：《实用肝脏病杂志》2020年第6期809-812,共4页Journal of Practical Hepatology

基　　金：2019年河北省重点研发计划项目(编号:19277779D)。

摘　　要：目的探讨血浆高尔基体蛋白73(GP73)水平联合肝脏硬度测定(LSM)诊断慢性乙型和丙型肝炎患者肝纤维化分期的价值。方法2015年6月~2019年1月我院收治的慢性乙型肝炎患者46例,慢性丙型肝炎患者98例,乙型肝炎肝硬化患者17例,丙型肝炎肝硬化患者35例,另选择健康人56例,使用Fibrotouch检测LSM,采用ELISA法检测血浆GP73水平。对肝病患者行肝活检。应用受试者工作特征曲线(ROC)分析GP73、LSM及两者联合诊断肝纤维化的效能。结果在本组196例患者中,经病理学检查,诊断为S 1期45例(23.0%),S 2期50例(25.5%),S 3期49例(25.0%)和S 4期52例(26.5%),其中≥S 2期者151例(77.0%),≥S 3期者101例(51.5%);S 1、S 2、S 3和S 4期患者血浆GP73水平分别为(118.1±30.6)ng/ml、(135.8±39.7)ng/ml、(175.8±54.8)ng/ml和(228.7±74.6)ng/ml,LSM分别为(6.1±1.8)kpa、(10.1±2.2)kpa、(15.3±4.5)kpa和(23.0±9.4)kpa,均显著高于健康人[分别为为(94.0±19.4)ng/ml和(5.4±2.0)kpa,P<0.05];ROC曲线分析显示,GP73诊断肝纤维化≥S 2、≥S 3和S 4的截断点分别为127.7 ng/ml、142.5 ng/ml和155.6 ng/ml,LSM诊断的截断点分别为8.8 kPa、12.6 kPa和17.9 kPa,两者联合诊断的ROC下面积(AUC)分别为0.917(95%CI:0.875~0.948)、0.954(95%CI:0.920~0.977)和0.950(95%CI:0.914~0.973),其灵敏度分别为71.5%、86.1%和88.5%,其特异度分别为94.6%、95.1%和89.1%,准确性分别为96.8%、92.3%和90.7%。结论应用血浆GP73联合LSM诊断乙型和丙型肝炎患者肝纤维化的效能较好,值得临床进一步验证。Objective The aim of this study was to explore the diagnostic diagnostic values of plasma Golgi protein 73(GP73)and liver stiffness measurement(LSM)combination for liver fibrosis in patients with hepatitis B and C.Methods 46 patients with hepatitis B,98 patients with hepatitis C,17 patients with hepatitis B liver cirrhosis and 35 patients with hepatitis B liver cirrhosis as well as 56 healthy persons were enrolled in our hospital between June 2015 and January 2019,and plasma GP73 levels were detected by ELISA and LSM was obtained by Fibrotouch.Liver biopsies were performed in all the patients.The diagnostic efficacy was evaluated by area under ROC.Results Out of our series,the histopathological examination showed that liver fibrosis staging(S)1 in 45(23.0%),S 2 in 50(25.5%),S 3 in 49(25.0%)and S 4 in 52 patients(26.5%),with≥S 2 in 151(77.0%)and≥S 3 in 101(51.5%);plasma GP73 levels in patients with S 1,S 2,S 3 and S 4 were(118.1±30.6)ng/ml,(135.8±39.7)ng/ml,(175.8±54.8)ng/ml and(228.7±74.6)ng/ml,and LSM were(6.1±1.8)kpa,(10.1±2.2)kpa,(15.3±4.5)kpa and(23.0±9.4)kpa,respectively,all significantly higher than(94.0±19.4)ng/ml and(5.4±2.0)kpa(P<0.05)in healthy persons;the cut-off-value of plasma GP73 in diagnosing liver fibrosis≥S 2,≥S 3 and equal to S 4 were 127.7 ng/ml,142.5 ng/ml and 155.6 ng/ml,and that of LSM were 8.8 kPa,12.6 kPa and 17.9 kPa,and the diagnostic area under ROC of the two combination were 0.917(95%CI:0.875-0.948),0.954(95%CI:0.920-0.977)and 0.950(95%CI:0.914-0.973),with the sensitivity of 71.5%,86.1%and 88.5%,the specificity of 94.6%,95.1%and 89.1%,and accuracy of 96.8%,92.3%and 90.7%,respectively.Conclusion The application of plasma GP73 level and LSM combination in predicting liver fibrosis in patients with chronic hepatitis B and hepatitis C is feasible and simple,which warrants further investigation.

关 键 词：乙型肝炎 丙型肝炎 肝纤维化 肝脏硬度检测 高尔基体蛋白73 诊断试验 

分 类 号：R512.6[医药卫生—内科学] R575.2[医药卫生—临床医学]