血清壳多糖酶3样蛋白1水平与肝脏弹性值测定对肝纤维化诊断价值的比较  

Comparison of the Diagnostic Value of Serum Chitinase 3-like Protein 1 Level and Liver Elasticity in the Diagnosis of Liver Fibrosis

作　　者：毛卓 廖爱军[1] 廖金卯[2] 胡小宣[2] MAO Zhuo;LIAO Ai-jun;LIAO Jin-mao(Department of Gastroenterology,the First Affiliated Hospital of Nanhua University,Changsha,Hunan 421000)

机构地区：[1]南华大学附属第一医院消化内科,湖南衡阳421000 [2]湖南省人民医院肝病内科,湖南长沙410005

出　　处：《医学临床研究》2021年第6期806-810,共5页Journal of Clinical Research

基　　金：湖南省教育厅一般项目(19C112);长沙市科技局一般项目(kq1907066)。

摘　　要：【目的】比较血清壳多糖酶3样蛋白1(CHI3L1)水平与肝脏弹性值测定对肝纤维化的诊断价值。【方法】收集2018年9月到2019年12月于湖南省人民医院肝病内科门诊及住院患者共392例,采用Fibroscan测定肝脏弹性值(LS),将LS值≤7.3kPa者纳入无纤维化组(n=115),LS值≤17.4kPa者纳入纤维化组(n=85),LS值≥17.5kPa纳者入至肝硬化组(n=192)。采用酶联免疫吸附法(ELISA)检测所有研究对象血清CHI3L1水平,采用全自动生化分析仪测定患者肝功能指标(ALT、AST、TBIL、DBIL、TP、ALB)。分析CHI3L1与肝功能指标的相关性,绘制血清CHI3L1水平及LS值对肝纤维化患者诊断价值的ROC曲线。【结果】比较三组患者临床资料,其中年龄、BMI、合并饮酒史的例数比较,差异具有统计学意义(P<0.05)。各组CHI3L1水平、LS值、肝功能指标(ALT、AST、TBIL、DBIL、TP、ALB)组间比较,差异均具有统计学意义(P<0.05)。无纤维化组CHI3L1水平与各项肝功能指标及LS值无相关性(P>0.05);纤维化组血清CHI3L1水平与各项肝功能指标无相关性(P>0.05),与LS呈正相关(P<0.05);肝硬化组血清CHI3L1水平与ALT和LS呈正相关,与ALB呈负相关(P<0.05),与AST、TBIL、DBIL、TP无相关性(P>0.05)。血清CHI3L1水平及LS值曲线下面积分别是0.841及0.717,两者检测方法对肝纤维化患者诊断效能均较高,其中血清CHI3L1诊断效能略高于LS值。【结论】血清CHI3L1水平与ALT、ALB等肝功能指标密切相关,可反映肝脏早期损伤。与Fibroscan相比,血清CHI3L1水平在肝纤维化患者中具有较高诊断效能,值得临床推广。【Objective】To explore the diagnostic value of the serum chitinase 3-like protein 1(CHI3L1)level and Fibroscan in patients with liver fibrosis.【Methods】A total of 392 outpatients and inpatients in the Department of Liver Diseases of Hunan Provincial People's Hospital from September 2018 to December 2019 were collected.Fibroscan was used to measure liver elasticity(LS).LS value≤7.3 kPa was included in the non-fibrosis group(n=115),LS value≤17.4 kPa was included in the fibrosis group(n=85),and LS value≥17.5 kPa was included in the cirrhosis group group(n=192).Enzyme-linked immunosorbent assay(ELISA)was used to detect serum CHI3L1 levels in all subjects,an automatic biochemical analyzer was used to determine patient liver function indexes(ALT,AST,TBIL,DBIL,TP,ALB),and Fibroscan was used to determine liver stiffness(LS).The correlation between CHI3L1 and liver function indexes was analyzed and the ROC curve of serum CHI3L1 level and LS value in the diagnosis of liver fibrosis patients was drawn.【Results】The clinical data of the three groups of patients were compared,and the difference of age,BMI,combined drinking history were statistically significant(P<0.05).The CHI3L1,LS,liver function indexes(ALT,AST,TBIL,DBIL,TP,ALB)of each group were compared,and the differences were statistically significant(P<0.05).The level of CHI3L1 in the non-fibrosis group was not correlated with various liver function indexes and LS values(P>0.05).The level of serum CHI3L1 in the fibrosis group was not correlated with various liver function indexes(P>0.05),but positively correlated with LS(P<0.05).Serum CHI3L1 level in the cirrhosis group was positively correlated with ALT and LS,negatively correlated with ALB(P<0.05),and not correlated with AST,TBIL,DBIL,TP(P>0.05).The area under curve of the serum CHI3L1 and LS value are 0.841 and 0.717,respectively.Both methods have high diagnostic efficiency for patients with liver fibrosis,and the diagnostic efficiency of serum CHI3L1 is slightly higher than the LS value.【Conclusio

关 键 词：肝硬化/诊断 弹性成像技术 壳多糖酶3样蛋白质1/血液 

分 类 号：R657.31[医药卫生—外科学]