新型肝纤维化标志物评估慢性丙型肝炎患者肝硬化的诊断价值  

Diagnostic value of novel hepatic fibrosis markers in assessing cirrhosis in patients with chronic hepatitis C

作　　者：亢倩 刘建湘[1] 谭宁 陈宏宇 潘家莉 韩一凡 徐小元[2] Kang Qian;Liu Jianxiang;Tan Ning;Chen Hongyu;Pan Jiali;Han Yifan;Xu Xiaoyuan(Department of Infectious Diseases,Peking University First Hospital,Beijing 100034,China;Department of Gastroenterology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院感染疾病科,北京100034 [2]北京大学第一医院消化内科,北京100034

出　　处：《中华肝脏病杂志》2023年第1期56-64,共9页Chinese Journal of Hepatology

基　　金：十三五国家科技重大专项(2017ZX10203202-003);北京市科委重大专项(D161100002716003)。

摘　　要：目的探讨在直接抗病毒药物(DAAs)经治的慢性丙型肝炎(CHC)患者中,壳多糖酶3样蛋白1(CHI3L1)、高尔基体蛋白73(GP73)诊断肝硬化的效能及丙型肝炎病毒清除后CHI3L1、GP73的动态变化特点。方法收集从2017年1月至2019年12月确诊的105例丙型肝炎患者的资料,绘制受试者操作特征曲线(ROC)来研究血清CHI3L1、GP73诊断肝硬化的效能,Friedman检验用于比较CHI3L1、GP73的变化特点。正态分布的连续变量比较采用方差分析和t检验进行统计分析;非正态分布的连续变量比较采用秩和检验进行统计分析;分类变量用Fisher精确检验和χ2检验进行统计分析;相关分析用Spearman相关分析法。结果基线时CHI3L1及GP73诊断肝硬化的ROC下面积为0.939和0.839。DAAs组患者血清CHI3L1及GP73水平在治疗结束时与基线相比显著下降[123.79(60.25,178.80)ng/ml与118.20(47.68,151.36)ng/ml,P=0.001;105.73(85.05,130.69)ng/ml与95.52(69.52,118.97)ng/ml,P=0.001];聚乙二醇干扰素联合利巴韦林(PR)组患者血清CHI3L1及GP73在治疗结束第24周时与基线相比显著下降[89.15(39.15,149.74)ng/ml与69.98(20.52,71.96)ng/ml,P<0.05;85.07(60.07,121.00)ng/ml与54.17(29.17,78.65)ng/ml,P<0.05]。结论CHI3L1及GP73是敏感的血清学标志物,可用于监测治疗期间和达到持续病毒学应答后CHC患者的纤维化转归。DAAs组患者血清CHI3L1及GP73水平下降较PR组患者早,未治疗组患者血清CHI3L1水平在随访约2年时较基线升高。Objective To investigate the efficacy of chitinase-3-like protein 1(CHI3L1)and Golgi protein 73(GP73)in the diagnosis of cirrhosis and the dynamic changes of CHI3L1 and GP73 after HCV clearance in patients with chronic hepatitis C(CHC)treated with direct-acting antiviral drugs(DAAs).The comparison of continuous variables of normal distribution were statistically analyzed by ANOVA and t-test.The comparison of continuous variables of non-normal distribution were statistically analyzed by rank sum test.The categorical variables were statistically analyzed by Fisher's exact test andχ2 test.Correlation analysis was performed using Spearman correlation analysis.Methods Data of 105 patients with CHC diagnosed from January 2017 to December 2019 were collected.The receiver operating characteristic curve(ROC curve)was plotted to study the efficacy of serum CHI3L1 and GP73 for the diagnosis of cirrhosis.Friedman test was used to compare CHI3L1 and GP73 change characteristics.Results The areas under the ROC curve for CHI3L1 and GP73 in the diagnosis of cirrhosis at baseline were 0.939 and 0.839,respectively.Serum levels of CHI3L1 and GP73 in the DAAs group decreased significantly at the end of treatment compared with baseline[123.79(60.25,178.80)ng/ml vs.118.20(47.68,151.36)ng/ml,P=0.001;105.73(85.05,130.69)ng/ml vs.95.52(69.52,118.97)ng/ml,P=0.001].Serum CHI3L1 and GP73 in the pegylated interferon combined with ribavirin(PR)group were significantly lower at the end of 24 weeks of treatment than the baseline[89.15(39.15,149.74)ng/ml vs.69.98(20.52,71.96)ng/ml,P<0.05;85.07(60.07,121)ng/ml vs.54.17(29.17,78.65)ng/ml,P<0.05].Conclusion CHI3L1 and GP73 are sensitive serological markers that can be used to monitor the fibrosis prognosis in CHC patients during treatment and after obtaining a sustained virological response.Serum CHI3L1 and GP73 levels in the DAAs group decreased earlier than those in the PR group,and the serum CHI3L1 levels in the untreated group increased compared with the baseline at about two years of follow-up

关 键 词：慢性丙型肝炎 纤维化 直接抗病毒药物 壳多糖酶3样蛋白1 高尔基体蛋白73 

分 类 号：R512.63[医药卫生—内科学] R575.2[医药卫生—临床医学]