低密度脂蛋白和高密度脂蛋白亚类鉴定在乙型肝炎病毒相关性肝癌发生风险预测中的意义  

Significance of identification of low-density lipoprotein and high-density lipoprotein subclasses in the risk prediction of HBV-related liver cancer

作　　者：罗恒 卫向红 吴清明[2] 向世强 张若涵 LUO Heng;WEI Xianghong;WU Qingming(School of Public Health,Wuhan University of Science and Technology,Wuhan 430065,China;不详)

机构地区：[1]武汉科技大学公共卫生学院,430065 [2]武汉科技大学临床学院 [3]武汉科技大学基础医学院 [4]空军军医大学第一附属医院肝胆胰脾外科

出　　处：《临床外科杂志》2022年第9期875-879,共5页Journal of Clinical Surgery

基　　金：国家自然科学基金项目(81702329)。

摘　　要：目的 探讨低密度脂蛋白(LDL)和高密度低脂蛋白(HDL)亚类鉴定在乙型肝炎病毒(HBV)相关性肝癌发生风险预测中的临床意义。方法 2017年1月~12月,前瞻性纳入90例在空军军医大学第一附属医院接受诊断和治疗的HBV携带者,分为肝癌组(n=30)、肝硬化组(n=30)和慢性肝病组(n=30)。聚丙烯酰胺凝胶电泳分析血清LDL亚类,血清HDL亚类通过二维凝胶电泳和免疫印迹法确定。比较各组临床资料和血清LDL、HDL亚类水平,Logistic模型分析影响肝癌发生风险的危险因素。受试者工作特征(ROC)曲线分析各指标的预测效能。结果 与慢性肝炎组比较,肝硬化组和肝癌组患者血清小而密LDL(sdLDL)水平显著上升,同时血清HDL2、HDL3水平显著降低,均P<0.05。且肝癌组患者血清sdLDL水平高于肝硬化组,血清HDL2、HDL3水平低于肝硬化组,均P<0.05。经Logistic回归分析,血清sdLDL水平上升、HDL3水平下降是影响慢性肝病患者发生肝癌的独立危险因素,P<0.05。经ROC曲线分析,血清sdLDL、HDL3预测肝癌发生的曲线下面积为0.899(0.835~0.964)、0.816(0.731~0.902),特异度0.883、0.976,灵敏度0.867、0.600。结论 血清sdLDL和HDL3水平与HBV相关性肝癌的发生风险有关,监测血清sdLDL和HDL3水平有助于肝癌的早期诊断。Objective To explore the clinical significance of identification of low-density lipoprotein(LDL) and high-density low lipoprotein(HDL) subclasses in the risk prediction of hepatitis B virus(HBV)-related liver cancer.Methods From January to December 2017,90 HBV carriers diagnosed and treated in the First Affiliated Hospital of the Air Force Military Medical University were prospectively included, and they were divided into liver cancer group(n=30),liver cirrhosis group(n=30) and chronic liver disease group(n=30).Serum LDL subtypes were analyzed by polyacrylamide gel electrophoresis, and serum HDL subtypes were determined by two-dimensional gel electrophoresis and western blotting.The clinical data of each group and the levels of serum LDL and HDL subtypes were compared, and the risk factors affecting the occurrence and prognosis of liver cancer were analyzed by Logistic regression model.The predictive efficacy of each index was analyzed by the receiver operating characteristic(ROC) curve.Results Compared with the chronic hepatitis group, Small and dense(sd) LDL levels in patients with liver cirrhosis and liver cancer increased significantly, and serum HDL2 and HDL3 levels decreased significantly, both P<0.05.In addition, the serum sdLDL level of the liver cancer group was higher than that of the liver cirrhosis group, and the serum HDL2 and HDL3 levels were lower than that of the liver cirrhosis group, both P<0.05.Logistic regression analysis showed that the increase of serum sdLDL level and the decrease of HDL3 level are independent risk factors of liver cancer in patients with chronic liver disease, P<0.05.After ROC curve analysis, the area under the curve of serum sdLDL and HDL3 predicting the occurrence of liver cancer was 0.899(0.835-0.964) and 0.816(0.731-0.902),the specificities were 0.883,0.976,the sensitivities were 0.867,0.600.Conclusion Serum sdLDL and HDL3 levels are related to the risk of HBV-related liver cancer.Monitoring serum sdLDL and HDL3 levels is helpful for early diagnosis of liver cancer.

关 键 词：低密度脂蛋白 高密度脂蛋白 肝癌 sdLDL 

分 类 号：R512.62[医药卫生—内科学] R735.7[医药卫生—临床医学]