肝纤维化血清标志物与HBV-DNA联合检测在慢性乙肝疾病进程中的应用价值  

Application Value of Serum Liver Fibrosis Markers and HBV-DNA in Disease Progression after Chronic Hepatitis B Disease

作　　者：任婷玉 廖奕浪 林芳楠 宋春丽 王大明 周义文 REN Tingyu;LIAO Yilang;LIN Fangnan;SONG Chunli;WANG Daming;ZHOU Yiwen(Shenzhen Hospital of Southern Medical University,Shenzhen 518000,China;不详)

机构地区：[1]南方医科大学深圳医院,广东深圳518000 [2]吉林大学

出　　处：《中国医学创新》2021年第10期28-33,共6页Medical Innovation of China

基　　金：国家自然科学青年基金项目(81702088);广东省自然科学基金项目(2018A030313740);广东省医学科学技术研究基金项目(B2018013);南方医科大学深圳医院苗苗计划项目(2018MM02)。

摘　　要：目的:探究肝纤维化标志物和HBV-DNA联合检测在慢性HBV感染后疾病进程中的应用价值。方法:回顾性分析2017年1月-2019年12月诊断为HBV携带者58例(对照组)、慢性乙型肝炎患者107例(慢性乙型肝炎组)、乙肝肝硬化患者34例(肝硬化组)的病历资料,检测并观察三组的肝纤维化标志物HA、PCⅢ、Ⅳ-C、LN和HBV-DNA载量,分析各指标之间及各指标与疾病进程的相关性,并绘制受试者工作特征(ROC)曲线。结果:肝纤维化四项指标HA、PCⅢ、Ⅳ-C、LN在对照组、慢性乙型肝炎组、肝硬化组中的含量依次增加,HBV-DNA载量在慢性乙型肝炎组中最高,其次是对照组;各指标在各组中的检测结果比较,差异均有统计学意义(P<0.05)。血清肝纤维化四项指标HA、PCⅢ、Ⅳ-C、LN之间均呈正相关关系(P<0.01),其中PCⅢ与Ⅳ-C之间为高度相关(r_(s)=0.897,P<0.01)。血清肝纤维化四项指标HA、PCⅢ、Ⅳ-C、LN与HBV感染后疾病发展呈正相关(P<0.05),其中HA与HBV感染后疾病进程显著相关(r_(s)=0.548,P<0.01)。HA、PCⅢ、Ⅳ-C、LN、HBV-DNA单一检测对应AUC分别为0.925、0.929、0.916、0.899、0.630,联合检测对应AUC为0.959。结论:HBV在慢性乙型肝炎患者中呈现较高水平的复制,在肝硬化阶段复制水平降低。肝纤维化四项指标在HBV感染后随着疾病发展含量升高,其含量与疾病发展呈正相关关系,HA、PCⅢ、Ⅳ-C、LN四项指标之间也具有正相关关系,其中PCⅢ与Ⅳ-C含量高度相关,HA含量与疾病进程明显相关。联合检测肝纤维化四项血清学标志物与HBV-DNA载量可提高肝纤维化的诊断效能。Objective:To explore the application value of HBV-DNA and serological markers for liver fibrosis on disease progression in chronic HBV infected patients.Method:From January 2017 to December 2019,the data of 58 patients with HBV carriers(control group),107 patients with chronic hepatitis B(chronic hepatitis B group),34 patients with chronic hepatitis B cirrhosis(cirrhosis group)were analyzed retrospectively,the levels of HA,PCⅢ,Ⅳ-C,LN in liver fibrosis markers and HBV-DNA of the three groups were detected and observed,the correlation between the indicators and the disease progression was analyzed,and the receiver operating characteristic(ROC)curve was drawn.Result:The four indexes of liver fibrosis HA,PCⅢ,Ⅳ-C and LN increased in the control group,chronic hepatitis B group and cirrhosis group successively,HBV-DNA load was the highest in the chronic hepatitis B group,followed by the control group.There were significant differences in the detection results among the indicators in each group(P<0.05).There was a positive correlation between four indexes of serum fibrosis HA,PCⅢ,Ⅳ-C and LN(P<0.01),PCⅢwas highly correlated withⅣ-C(r_(s)=0.897,P<0.01).Serum liver fibrosis four indicators HA,PCⅢ,Ⅳ-C and LN were positively correlated with disease development after HBV infection(P<0.05),HA was significantly correlated with disease progression after HBV infection(r_(s)=0.548,P<0.01).The AUC of HA,PCⅢ,Ⅳ-C,LN and HBV-DNA were 0.925,0.929,0.916,0.899 and 0.630,respectively,the AUC of combined detection was 0.959.Conclusion:HBV replicates at a higher level in patients with chronic hepatitis B and decreases at the stage of cirrhosis.The four indexes of liver fibrosis increased with the development of the disease after HBV infection,and their content is positively correlated with the development of the disease.There is also a positive correlation between the four indexes of HA,PCⅢ,Ⅳ-C,and LN,among which the content of PCⅢis highly correlated with the content ofⅣ-C,and the content of HA is significant

关 键 词：乙型肝炎 肝纤维化 血清标志物 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]