血红素加氧酶1及HAP模型诊断慢性乙型肝炎肝纤维化的研究  

Study on heme oxygenase-1 and HAP model for the diagnosis of chronic hepatitis B-related liver fibrosis

作　　者：薛宁宁 苑喜微 赵文[1] 汤玉会 张潇潇 王一奇 赵丹丹[1] 南月敏[1] Xue Ningning;Yuan Xiwei;Zhao Wen;Tang Yuhui;Zhang Xiaoxiao;Wang Yiqi;Zhao Dandan;Nan Yuemin(Department of Traditional and Western Medical Hepatology,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院中西医结合肝病科,石家庄050051

出　　处：《中华肝脏病杂志》2021年第8期743-747,共5页Chinese Journal of Hepatology

基　　金：2019年河北省重点研发计划项目(19277779D);河北省引进国外智力项目。

摘　　要：目的明确血浆血红素加氧酶1(HO-1)在慢性乙型肝炎肝纤维化发生和发展及其病理分期中的诊断价值。方法选择河北医科大学第三医院门诊及住院慢性乙型肝炎(CHB)患者211例,健康对照组57例。同步收集研究对象的临床资料、外周血常规及血清生物化学检测结果;血浆HO-1水平采用酶联免疫吸附法(ELISA)检测。依据肝活检、肝硬度值(LSM)进行肝纤维化(SI~4)分期。统计学分析采用二元logistic回归分析乙型肝炎肝纤维化独立危险因素,以此建立诊断模型,应用受试者操作特征曲线(ROC)对比分析HO-1、新建模型及FIB-4、APRI诊断肝纤维化分期效能。结果CHB患者血浆HO-1水平显著高于健康对照,分别为10.11(7.08~13.12)ng/ml、6.71(5.56~8.45)ng/ml,P<0.001。肝纤维化S1、S2、S3、S4期依次为37、38、38、98例,血浆HO-1水平依次为(6.91±2.80)ng/ml、(8.24±2.44)ng/ml、(9.96±3.46)ng/ml、(12.65±3.70)ng/ml,P<0.001。HO-1、白蛋白、血小板(PLT)为肝纤维化的独立危险因素,建立HAP模型,HAP、FIB-4及APRI诊断肝纤维化分期灵敏度、特异度依次为:≥S2为84.62%、72.35%、81.18%和83.78%、81.08%、67.57%;≥S3依次为80.15%、82.09%、85.82%和88.64%、76.19%、60.32%;S4为90.82%、82.29%、86.46%和74.37%、65.77%、48.65%。结论血浆HO-1水平可反映肝纤维化的严重程度,HAP诊断模型可较FIB-4、APRI更准确反映肝纤维化进程,指导临床诊断及预后评估。Objective To determine the diagnostic value of plasma heme oxygenase I(HO-1)in the occurrence,development,and pathological stages of chronic hepatitis B related liver fibrosis.Methods 211 outpatients and inpatients with chronic hepatitis B(CHB)and 57 healthy controls who visited the Third Hospital of Hebei Medical University were selected.Simultaneously,clinical data,peripheral blood routine and serum biochemical test results of the research subects were collected.Plasma HO-1 levels were detected by enzyme-linked immunosorbent assay(ELISA).Liver fibrosis(SI~4)was staged according to liver biopsy and liver stifiness measurement(LSM).Statistical analysis:binary logistic regression was used to analyze the independent risk factors of hepatitis B-related liver fibrosis to establish a diagnostic model,and the receiver operating characteristic curve(ROC)was used to compare and analyze the staging eficiency of HO-1,new model,FIB 4 and APRI for the diagnosis of liver fibrosis.Results Plasma HO-1 levels were significantly higher in CHB patients than healthy controls[10.11(7.08~13.12)ng/ml and 6.71(5.56~8.45)ng/ml,(P<0.001)].There were 37,38,38,and 98 cases with liver fibrosis stages SI,S2,S3,and S4,respectively and plasma HO-1 level was(6.91±2.80)ng/ml,(8.24±2.44)ng/ml,(9.96±3.46)ng/ml,(12.65±3.70)ng/ml,P<0.001.HO-1,albumin,and platelets(PLT)were independent risk factors for liver fibrosis.A HAP model was established.HAP,FIB-4 and APRI sensitivity and specificity for the diagnosis of liver fibrosis staging were as follows:≥S2 were 84.62%,72.35%,81.18%and 83.78%,81.08%,67.57%;≥S3 were 80.15%,82.09%,85.82%and 88.64%,76.19%,60.32%;S4 were 90.82%,82.29%,86.46%and 74.37%,65.77%,48.65%,respectively.Conclusion Plasma HO-1 level can reflect the severity of liver fibrosis.HAP diagnostic model can more accurately mirror the process of liver fibrosis than FIB-4 and APRI,and point clinical diagnosis and prognosis asessment.

关 键 词：慢性乙型肝炎 肝纤维化 血红素加氧酶1 诊断模型 

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