细胞角蛋白18联合受控衰减参数对慢性乙肝合并代谢相关脂肪性肝病的诊断价值  

Diagnostic value of CAP,cytokeratin 18 and low-density lipoprotein cholesterolfor chronic hepatitis B with metabolic-dysfunction-associated fatty liver disease

作　　者：赵黎莉[1] 李嘉[1] 王春妍[1] Zhao Lili;Li Jia;Wang Chunyan(Department of Gastroenterology and Hepatology,Tianjin Second People’s Hospital,Tianjin 300192,China)

机构地区：[1]天津市第二人民医院肝病科,天津300192

出　　处：《实用器官移植电子杂志》2021年第1期37-41,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：天津市第二人民医院院所级项目(YS-0014)。

摘　　要：目的探讨血清细胞角蛋白18片段M 30(CK18M30)及片段M65(CK18M65)、血脂、受控衰减参数(controlled attenuation parameter,CAP)在慢性乙肝(chronic hepatitis B,CHB)合并代谢相关脂肪性肝病(metabolic-dysfunction-associated fatty liver disease,MAFLD)的诊断效能。方法选取CHB合并MAFLD患者105例。ELISA检测各组患者血清CK18M30、CK18M65,瞬时弹性成像技术(Fibroscan)检测CAP,腹部超声了解肝脏脂肪变性情况。通过logistic回归分析,采用受试者工作特征曲线下面积(AUC)评估联合血清CK-18、血脂及CAP对CHB合并MAFLD的诊断效能。结果MAFLD组、CHB组和CHB合并MAFLD组在丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)、碱性磷酸酶(alkaline phosphatase,ALP)、γ-谷氨酰转肽酶(Gamma-glutamyl transpeptidase,GGT)、空腹血糖(fasting blood-glucose,FBG)、高密度脂蛋白(high-density lipoprotein,HDL)、CK18M30比较无明显差异(P>0.05);在CAP、TC、LDL及BMI比较在MAFLD组、CHB合并MAFLD组明显高于CHB组(P<0.05);CK18M65在CHB合并MAFLD高于MAFLD、CHB组(P<0.05);CK18M30、CK18M65、CAP、CAP-CK18M65、CAP-CK18M65-TC和CAP-CK18M65-LDL诊断CHB合并MAFLD的AUC分别为0.572(0.455~0.683)、0.651(0.535~0.755)、0.737(0.626~0.830)、0.774(0.666~0.860)、0.797(0.691~0.879)和0.837(0.728~0.915)。CAP、CK18 M65及LDL-C的联合指标回归模型诊断CHB合并MAFLD的最高为0.837,敏感度和特异度分别为0.811和0.719。结论联合CAP、CK18M65及LDL 3项指标的回归模型对CHB合并MAFLD有更高的诊断价值。Objective To investigate the diagnostic value of cytokeratin 18 M30(CK18M30)and M65(CK18M65),blood lipids and controlled attenuation parameter(CAP)in chronic hepatitis B(CHB)with metabolicdysfunction-associated fatty liver disease(MAFLD).Methods A total of 105 CHB patients concomitant with MAFLD patients were included from April 2019 to April 2020 were.Serum CK18M30,CK18M65 levels were measured by enzyme linked immunosorbent assay(ELISA);CAP was measured by Fibroscan;and ultrasonography was used to assessed the extent of hepatic steatosis.The index of serum CK18,blood lipids and CAP was analyzed by binary logistic regression,and the diagnostic value of the above indexes for CHB with MAFLD was evaluated by the areas under the receiver operating characteristic curve(AUC).Results ALT,AST,ALP,GGT,FBG,HDL,CK18M30 levels between MAFLD,CHB and CHB with MAFLD groups showed no significant statistical difference (P > 0.05). Compared to CHB group, the levels of CAP, TC, LDL and BMI were significantly higher in MAFLDand CHB with MAFLD groups(P < 0.05). CK18M65 level in CHB with MAFLD group was significantly higherthan in MAFLD and CHB groups(P < 0.05). The AUC of CK18M30, CK18M65, CAP, CAP-CK18M65, CAPCK18M65-TC and CAP-CK18M65-LDL for the diagnosis of CHB with MAFLD were 0.572(0.455 ~ 0.683),0.651(0.535 ~ 0.755), 0.737(0.626 ~ 0.830), 0.774(0.666 ~ 0.860), 0.797(0.691 ~ 0.879) and 0.837(0.728 ~0.915), respectively. Among the parameters, the combination of CAP, CK18M65 and LDL had the largest AUC andthe corresponding sensitivity and specificity were 0.811 and 0.719, respectively. Conclusion The combination ofCAP, CK18M65 and LDL has a superior diagnostic diagnastic value for CHB with MAFLD.

关 键 词：慢性乙肝 代谢相关性脂肪性肝病 细胞角蛋白18 受控衰减参数 血脂 诊断 

分 类 号：R512.62[医药卫生—内科学] R575.5[医药卫生—临床医学]