无创肝纤维化诊断指标在乙型肝炎伴肝硬化及肝癌进展程度中的意义  

Significance of Liver Fibrosis Diagnostic Indexes in Hepatitis B with Cirrhosis and Liver Cancer Progression

作　　者：徐少华 黄江华 朱琳 杨涛 宋娟 龚丽 郑崛村[3] 谢晓霞 Xu Shaohua;Huang Jianghua;Zhu Lin(Santai Hospital of Traditional Chinese Medicine,Mianyang,Sichuan 621100;The People Hospital of Santai County,Mianyang,Sichuan 621100,China)

机构地区：[1]四川中医药高等专科学校附属三台医院·三台县中医院,四川绵阳621100 [2]川北医学院附属三台医院·三台县人民医院,四川绵阳621100 [3]成都医学院,四川成都610083

出　　处：《四川医学》2024年第8期827-832,共6页Sichuan Medical Journal

基　　金：国家重大慢性疾病相关诊断试剂研发课题(编号:2019F000G501);四川省绵阳市卫生健康委员会科研课题(编号:202014,202322);“十三五”国家重点研发计划高端试剂可溯源量值定值技术及质量评价方法研究(编号:2019YFF0216500)。

摘　　要：目的应用由肝脏影像学、血清肝脏纤维化直接和间接标志物组成的无创肝脏纤维化诊断指标,评价其在乙型肝炎伴肝硬化及肝癌患者诊断中的应用价值,并对肝硬化严重程度进行预测。方法收集2020年1月至2023年12月在我院进行治疗的乙型肝炎病毒感染者214例,分为乙型肝炎组80例、肝硬化组76例和肝硬化伴肝癌组58例。检测患者无创肝纤维化指标:①肝脏影像学的肝脏硬度值(LSM);②血清肝纤维化直接标志物的Ⅲ型前胶原N端肽(PⅢP)、IV型胶原(IV)、层黏连蛋白(LN)、透明质酸(HA)、甘胆酸(CG);③血清肝纤维化间接标志物的血小板比率指数(APRI)、天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值(AST/ALT)、单胺氧化酶(MAO)、α-L-岩藻糖苷酶(AFU)、谷胱甘肽还原酶(GR)。分析无创肝纤维化指标在肝硬化、肝癌和肝癌Child-Pugh分级中的诊断价值。结果在3组的比较中,无创肝纤维化指标差异均有统计学意义(P<0.05),并随着病情的发展而升高。ROC曲线分析提示,LSM、PⅢP、LN、IV、HA、CG、MAO、AFU指标对于肝硬化诊断效能优于GR、APRI、AST/ALT指标;LSM、PⅢP、LN、IV、HA、AFU、APRI、AST/ALT指标对于肝硬化伴肝癌诊断效能优于CG、MAO、GR指标;LSM在肝硬化(AUC=0.862,敏感度78.33%,特异度90.01%)和肝硬化伴肝癌(AUC=0.918,敏感度88.89%,特异度92.07%)中诊断价值高于其他指标。肝硬化伴肝癌患者的LSM、PⅢP、LN、IV、HA、AFU、CG、GR诊断指标随着病情的发展而升高,与Child-Pugh分级呈正相关,差异均有统计学意义(P<0.05)。结论无创肝纤维化诊断指标在评估乙型肝炎引起的肝硬化、肝癌及Child-Pugh分级中的诊断价值存在差异,综合运用对肝硬化程度及进展预测有一定的评估价值。Objective To evaluate application value of non-invasive liver fibrosis diagnostic indicators composed of liver imaging,serum liver fibrosis direct and indirect markers in the diagnosis of patients with hepatitis B accompanied by cirrhosis and liver cancer,and to predict their severity.Methods From January 2020 to December 2023,total 214 patients with hepatitis B virus infection were collected and divided into hepatitis B group(n=80),liver cirrhosis group(n=76)and liver cirrhosis with liver cancer group(n=58).Noninvasive liver fibrosis indexes were detected:①liver stiffness value(LSM)of liver imaging;②serum direct markers of liver fibrosis,such as typeⅢprocollagen N-terminal peptide(PⅢP),type IV Collagen(IV),laminin(LN),hyaluronic acid(HA),glycocholic acid(CG);③serum indirect marhers of liver fibrosis,such as platelet ratio index(APRI),aspartate aminotransferase to alanine aminotransferase ratio(AST/ALT),monoamine oxidase(MAO),andα-l-fucosidase(AFU),glutathione reductase(GR).The noninvasive liver fibrosis index was used to analyze the diagnostic value in the Child Pugh grading of liver cirrhosis and liver cancer.Results In the comparison of 3 groups,differences of noninvasive liver fibrosis indexes were statistically significant(P<0.05),and increased with the development of the disease.ROC curve analysis showed that LSM,PⅢP,LN,IV,HA,CG,MAO,AFU were better than GR,APRI,AST/ALT to diagnose liver cirrhosis.LSM,PⅢP,LN,IV,HA,AFU,APRI,AST/ALT were better than CG,MAO,GR to diagnose liver cirrhosis with liver cancer.The diagnostic value of LSM in liver cirrhosis(AUC=0.862,sensitivity 78.33%,specificity 90.01%)and liver cirrhosis with liver cancer(AUC=0.918,sensitivity 88.89%,specificity 92.07%)was higher than other indicators.Diagnostic indexes of LSM,PⅢP,LN,IV,HA,AFU,CG,GR in patients with liver cirrhosis and liver cancer increased with the development of disease,and were positively correlated with Child Pugh classification with statistically significant differences(P<0.05).Conclusion There would be diff

关 键 词：肝脏纤维化 乙型肝炎 肝硬化 肝癌 肝硬度 

分 类 号：R446.112[医药卫生—诊断学]