血清补体C3对原发性胆汁性胆管炎相关肝纤维化分期的诊断价值  

Value of serum complement C3 in the diagnosis of liver fibrosis associated with primary biliary cholangitis

作　　者：周辉 牛斌 宓余强[2] 刘勇钢[3] 李萍[2] ZHOU Hui;NIU Bin;MI Yuqiang;LIU Yonggang;LI Ping(Clinical School of The Second People’s Hospital of Tianjin Medical University,Tianjin 300070,China;Department of Hepatology,Tianjin Second People’s Hospital,Tianjin 300192,China;Department of Pathology,Tianjin Second People’s Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学第二人民医院临床学院,天津300070 [2]天津市第二人民医院肝病科,天津300192 [3]天津市第二人民医院病理科,天津300192

出　　处：《临床肝胆病杂志》2023年第11期2596-2606,共11页Journal of Clinical Hepatology

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-059B);中国肝炎防治基金会王宝恩肝纤维化研究基金(2021038)。

摘　　要：目的探讨血清补体C3水平对原发性胆汁性胆管炎(PBC)肝纤维化分期的诊断价值。方法收集2012年1月—2022年10月在天津市第二人民医院就诊并行肝穿刺活检的108例PBC患者临床资料。依据Scheuer评分系统评估肝纤维化程度(S0~4),其中≥S2定义为显著肝纤维化,≥S3定义为进展期肝纤维化,S4定义为肝硬化。符合正态分布的计量资料两组间比较采用独立样本t检验,多组间比较采用单因素方差分析。不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H秩和检验。计数资料组间比较采用χ^(2)检验或Fisher精确检验。通过受试者工作特征曲线下面积(AUC)评估补体C3对PBC患者肝纤维化的诊断效能。采用Spearman相关分析评估补体C3与肝纤维化分期的相关性。结果本研究108例PBC患者中女性87例(80.6%),自身抗体阳性102例(94.4%)。肝纤维化分期S0期5例(4.6%),S1期41例(38.0%),S2期23例(21.3%),S3期25例(23.1%)、S4期14例(13.0%)。补体C3在不同肝纤维化分期患者中具有统计学差异(H=42.891,P<0.001)。随着肝纤维化程度的加重,补体C3的水平逐渐降低,呈负相关(r=-0.565,P<0.001)。LSM、AAR、APRI及FIB-4与补体C3的相关系数分别为-0.439(P<0.001)、-0.323(P=0.001)、-0.206(P=0.033)和-0.291(P=0.002)。多因素Logistic回归显示补体C3水平均为显著肝纤维化、进展期肝纤维化和肝硬化的独立预测因素,而LSM是显著肝纤维化和进展期肝纤维化的独立预测因素。ROC曲线分析显示,补体C3诊断显著肝纤维化、进展期肝纤维化及肝硬化的AUC分别为0.731、0.832和0.968,对应的cut-off值分别为1.445、1.235和1.005;补体C3联合LSM诊断显著肝纤维化、进展期肝纤维化及肝硬化的AUC分别为0.811、0.941和0.976。C3联合LSM诊断显著纤维化的AUC与补体C3的相比,差异具有统计学意义(Z=2.604,P=0.009);C3联合LSM诊断进展期肝纤维化的AUC与补体C3的相�Objective To investigate the value of serum complement C3 level in determining the stage of liver fibrosis in primary biliary cholangitis(PBC).Methods Clinical data were collected from 108 patients with PBC who attended Tianjin Second People’s Hospital and underwent liver biopsy from January 2012 to October 2022.The degree of liver fibrosis(S0-4)was assessed according to the Scheuer scoring system,with≥S2 defined as significant liver fibrosis,≥S3 defined as progressive liver fibrosis,and S4 defined as liver cirrhosis.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and a one-way analysis of variance was used for comparison between multiple groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.The area under the ROC curve(AUC)was used to evaluate the efficacy of complement C3 in the diagnosis of liver fibrosis in patients with PBC.The Spearman correlation analysis was used to investigate the correlation between complement C3 and liver fibrosis stage.Results Among the 108 patients with PBC,there were 87(80.6%)female patients and 102 patients(94.4%)with positive autoantibody.As for the stage of liver fibrosis,there were 5 patients(4.6%)in S0 stage,41(38.0%)in S1 stage,23(21.3%)in S2 stage,25(23.1%)in S3 stage,and 14(13.0%)in S4 stage.There was a significant difference in the level of complement C3 between the patients with different liver fibrosis stages(H=42.891,P<0.001).The level of complement C3 gradually decreased with the aggravation of liver fibrosis,with a negative correlation between them(r=−0.565,P<0.001).Liver stiffness measurement(LSM),aspartate aminotransferase/alanine aminotransferase ratio,aspartate aminotransferase-to-platelet ratio index,and fibrosis-4 were negatively correlated with

关 键 词：胆管炎 硬化性 肝纤维化 补体C3 

分 类 号：R575.2[医药卫生—消化系统]