血清壳多糖酶3样蛋白1和PLT的比值与FIB-4指数在慢性乙型肝炎轻、中度诊断效价的比较  

A Comparison of the Ratio of Serum Chitinase 3-like Protein-1 to PLT and FIB-4 Index in the Diagnosis of Mild and Moderate Chronic Hepatitis B

作　　者：李晓宇[1] 黄秀香[2] 叶迎宾 LI Xiaoyu;HUANG Xiuxiang;YE Yingbin(Department of Surgery,2.Department of Hepatology,3.Department of Clinical Laboratory,Handan Infectious Diseases Hospital,Handan 056002,China)

机构地区：[1]河北省邯郸市传染病医院外科,河北邯郸056002 [2]河北省邯郸市传染病医院肝病科,河北邯郸056002 [3]河北省邯郸市传染病医院检验科,河北邯郸056002

出　　处：《标记免疫分析与临床》2024年第9期1693-1697,共5页Labeled Immunoassays and Clinical Medicine

基　　金：河北省医学科学研究课题计划(编号:20240762)。

摘　　要：目的比较血清壳多糖酶3样蛋白1(CHI3L1)和PLT的比值(CPR)与FIB-4指数在慢性乙型肝炎轻、中度的诊断效价。方法收集2023年1月至2023年12月在本院就诊的慢性乙型肝炎(CHB)轻、中度患者122例,其中CHB轻度患者30例(CHB轻度组),CHB中度患者92例(CHB中度组)。男78例,女44例;最小年龄12岁,最大年龄68岁,平均38.3±11.1岁。另外选取30例健康体检者为对照组,男16例,女14例;年龄27~57岁,平均41.6±9.8岁。要求被检者在清晨空腹抽血检测PLT、ALT、AST和CHI3L1,计算项目为CPR和FIB-4指数。计量资料符合正态分布采用LSD-t检验、非正态分布采用Mann-Whitney U检验;计数资料组间采用卡方检验。采用MedCalc统计绘制受试者工作特征(ROC)曲线及95%可信区(95%CI)。结果(1)3组中的年龄、CHI3L1、PLT、ALT、AST、FIB-4和CPR差异有统计学意义(U=3.288、10.837、8.627、7.130、8.225、4.485、12.966,P<0.01)。其中CHB中度组中的CHI3L1、ALT、CPR高于CHB轻度组和对照组(P<0.05),且CHB轻度组高于对照组(P<0.05);CHB中度组中的AST、FIB-4高于CHB轻度组和对照组(P<0.05);CHB中度组中的PLT低于轻度组和对照组(P<0.05);CHB中度组的年龄低于轻度组(P<0.05)。(2)CHB轻度组患者的CHI3L1的ROC曲线显示,CHI3L1的AUC=0.774(95%CI 0.645~0.903);FIB-4的AUC=0.551(95%CI 0.401~0.701);CPR的AUC=0.742(95%CI 0.608~0.876)。CHI3L1和CPR的灵敏度和特异性均优于FIB-4。CHI3L1与FIB-4独立诊断比较,差异有统计学意义(Z=2.246,P<0.05);CPR与FIB-4独立诊断比较,差异有统计学意义(Z=2.183,P<0.05)。(3)CHB中度患者的CHI3L1的ROC曲线显示,CHI3L1的AUC=0.793(95%CI 0.717~0.870);FIB-4的AUC=0.722(95%CI 0.629~0.814);CPR的AUC=0.832(95%CI 0.762~0.901)。CHI3L1和CPR的灵敏度和特异性均优于FIB-4。CPR与FIB-4独立诊断比较,差异有统计学意义(Z=2.244,P<0.05)。结论CPR在CHB轻度和中度患者的AUC明显高于同组中FIB-4,且CPR的升高趋势与临床表现严重程度一致,可作为临床评估CObjective To compare the ratio of CHI3L1 to PLT and FIB-4 index in the diagnosis of mild and moderate chronic hepatitis B.Methods A total of 122 patients with mild and moderate chronic hepatitis B(CHB)admitted to our hospital from January,2023 to December,2023 were collected for the study,including 30 patients with mild CHB(mild CHB group)and 92 patients with moderate CHB(moderate CHB group).There were 78 males and 44 females in this cohort.The youngest study subject was 12 years old,while the oldest subject was 68 years old,with the mean age of 38.3±11.1 years old.PLT,ALT,AST and CHI3L1 were collected on an empty stomach status in the morning,and these items were calculated as CPR and FIB-4 index.LSD-t test was applied for measurement data conforming to normal distribution and Mann-Whitney U test was used for comparisons with non-normal distribution.Chi-square test was applied for comparisons between datasets.Receiver operating characteristic(ROC)curve was drawn and 95%confidence zone(95%CI)were obtained using MedCalc statistical system.Results(1)There were significant differences in age,CHI3L1,PLT,ALT,AST,FIB-4 and CPR among the three groups(U=3.288,10.837,8.627,7.130,8.225,4.485,12.966,P<0.01).CHI3L1,ALT and CPR in moderate CHB group were significantly higher than those in mild CHB group and control group(P<0.05),and those in mild CHB group were significantly higher than those in the control group(P<0.05).AST and FIB-4 in moderate CHB group were significantly higher than those in mild CHB group and control group(P<0.05).The PLT in moderate CHB group was significantly lower than that in mild CHB group and control group(P<0.05).The age of moderate CHB group was significantly lower than that of mild CHB group(P<0.05).(2)The ROC curve of CHI3L1 in mild CHB patients showed that the AUC of CHI3L1 was 0.774(95%CI 0.645-0.903).The AUC of FIB-4 was 0.551(95%CI 0.401-0.701)and the AUC for CPR was 0.742(95%CI 0.608-0.876).The sensitivity and specificity of CHI3L1 and CPR were superior to FIB-4.The difference between CHI

关 键 词：慢性乙型肝炎 血清壳多糖酶3样蛋白1 血小板 4因子的纤维化指数 

分 类 号：R512.62[医药卫生—内科学]