FibroTouch联合肝纤维化四项生化指标评估慢性血吸虫病肝病患者肝纤维化程度价值  

Effectiveness of FibroTouch combined with four hepatic fibrosis biomarkers for evaluation of the liver fibrosis degree among patients with chronic schistosomiasis-induced liver disorders

作　　者：洪叶[1] 牛雪花[1] 沈宇舟 周磊 黄丽萍 HONG Ye;NIU Xue-hua;SHEN Yu-zhou;ZHOU Lei;HUANG Li-ping(Department of Gastroenterology,The Third People’s Hospital of Kunshan City,Kunshan,Jiangsu 215300,China)

机构地区：[1]江苏省昆山市第三人民医院消化内科,江苏昆山215300

出　　处：《中国血吸虫病防治杂志》2021年第6期629-633,共5页Chinese Journal of Schistosomiasis Control

基　　金：江苏省血地寄科研项目(X202107)。

摘　　要：目的评价联合使用Fibro Touch技术及肝纤维化四项生化指标检测对慢性血吸虫病肝病患者肝纤维化程度的效果。方法以2021年1—3月昆山市第三人民医院收治的63例慢性血吸虫病肝病患者作为观察组,另选择同期在该院进行健康体检的50例健康志愿者作为对照组。用Fibro Touch技术检测两组研究对象肝脏硬度值(LSM),用化学发光法检测两组研究对象肝纤维化四项生化指标。绘制LSM、肝纤维化四项指标单独及联合应用诊断慢性血吸虫病肝病患者肝纤维化程度的受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价单独及联合使用两种方法诊断肝纤维化程度的价值。结果观察组共63例患者,其中男性28例、女性35例,平均年龄(65.34±12.56)岁,平均体质指数(24.47±11.05)kg/m^(2);对照组共50例,其中男性22例、女性28例,平均年龄(64.28±13.10)岁,平均体质指数(25.12±11.64)kg/m^(2)。两组研究对象性别构成比(χ^(2)=0.002,P>0.05)、年龄(t=0.437,P>0.05)、体质指数(t=0.303,P>0.05)差异均无统计学意义。观察组和对照组患者LSM[(8.65±5.22)vs.(3.24±1.10)k Pa;t=8.013,P<0.05]、Ⅳ型胶原(Ⅳ-C)[(51.80±9.45)vs.(30.10±10.34)ng/L;t=11.506,P<0.05]、Ⅲ型前胶原(PC-Ⅲ)[(77.28±17.22)vs.(48.62±9.54)ng/L;t=11.224,P<0.05]、透明质酸酶(HA)[(39.55±5.32)vs.(84.89±10.34)ng/L;t=30.158,P<0.05]和层黏连蛋白(LN)[(99.47±7.37)vs.(61.93±9.80)ng/L;t=22.496,P<0.05]水平差异均有统计学意义,前者均高于后者。Spearman相关分析显示,慢性血吸虫病肝病患者肝纤维化程度与LSM、Ⅳ-C、PC-Ⅲ、HA、LN水平均呈正相关(r_(s)=0.675、0.421、0.517、0.550、0.539,P均<0.01)。ROC曲线分析显示,LSM预测慢性血吸虫病肝病肝纤维化程度的AUC值为0.864(P<0.001),当约登指数最大时,LSM截断值为11.75 k Pa,灵敏度为71.43%,特异度为84.00%;肝纤维化四项指标预测慢性血吸虫病肝病肝纤维化程度的AUC值为0.577~0.670,截断值为70.174~Objective To evaluate the performance of FibroTouch in combination with four hepatic fibrosis biomarkers for assessment of the degree of hepatic fibrosis among patients with chronic schistosomiasis-induced liver disorders.Methods A total of 63 patients with chronic schistosomiasis-induced liver diseases admitted to The Third People’s Hospital of Kunshan City from January to March 2021 were enrolled as the observation group,while 50 healthy volunteers receiving health examinations in the hospital during the study period were randomly selected as the control group.The liver stiffness measurement(LSM)was determined using the Fibro Touch technique,and the serum levels of four hepatic fibrosis biomarkers were detected using chemiluminescence immunoassay,including type Ⅳ collagen(Ⅳ-C),type Ⅲ procollagen(PC-Ⅲ),hyaluronidase(HA)and laminin(LN).The receiver operating characteristic(ROC)curves of LSM and four hepatic fibrosis biomarkers alone and in combination for assessing the degree of hepatic fibrosis among patients with chronic schistosomiasis-induced liver disorders were plotted and the area under the ROC curve(AUC)was estimated to examine the value of LSM and four hepatic fibrosis biomarkers alone and in combination for assessing the degree of hepatic fibrosis.Results There were 63 subjects in the observation group,including 28 men and 35 women,and the participants had a mean age of(65.34±12.56)years and a mean body mass index(BMI)of(24.47±11.05)kg/m^(2).There were 50 subjects in the control group,including 22 men and 28 women,and the participants had a mean age of(64.28±13.10)years and a mean BMI of(25.12±11.64)kg/m^(2).There were no significant differences between the observation and control groups in terms of gender ratio(χ^(2)=0.002,P>0.05),age(t=0.437,P>0.05)or BMI(t=0.303,P>0.05).The LSM[(8.65±5.22)vs.(3.24±1.10)k Pa;t=8.013,P<0.05],Ⅳ-C[(51.80±9.45)vs.(30.10±10.34)ng/L;t=11.506,P<0.05],PC-Ⅲ[(77.28±17.22)vs.(48.62±9.54)ng/L;t=11.224,P<0.05],HA[(39.55±5.32)vs.(84.89±10.34)ng/L;t=30.158

关 键 词：慢性血吸虫病 肝纤维化 FibroTouch Ⅳ型胶原 Ⅲ型前胶原 透明质酸酶 层黏连蛋白 诊断效能 

分 类 号：R532.21[医药卫生—内科学]