血清高尔基体蛋白73联合肝脏硬度评估慢性乙型肝炎病毒感染患者肝纤维化进展的价值  

Combination of serum Golgi protein 73 and liver stiffness for assessing liver fibrosis progression in patients with chronic hepatitis B virus infection

作　　者：张璨 张欢欢[2] 高飞 任佩佩 罗明阳 闫冬 王馨 王莹莹 曾艳丽 ZHANG Can;ZHANG Huanhuan;GAO Fei;REN Peipei;LUO Mingyang;YAN Dong;WANG Xin;WANG Yingying;ZENG Yanli(Department of Infectious Diseases,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Infectious Diseases,Luoyang Central Hospital,Luoyang,Henan 471000,China;Department of Infectious Diseases,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China;Department of Infectious Diseases,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院感染科郑州大学人民医院,河南郑州450003 [2]洛阳市中心医院感染科,河南洛阳471000 [3]郑州大学人民医院河南省人民医院感染科,河南郑州450003 [4]河南大学人民医院河南省人民医院感染科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2024年第10期1013-1018,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省卫生计生科技英才海外研修工程(HWYX2019137);河南省中青年卫生健康科技创新优秀青年人才培养项目(YXKC2020042)。

摘　　要：目的观察血清高尔基体蛋白73(GP73)水平及肝脏硬度在不同肝纤维化分期慢性乙型肝炎病毒(HBV)感染患者中变化,探讨二者在评估肝纤维化进展中的价值。方法2018年1月—2019年10月河南省人民医院诊治慢性HBV感染患者475例,行经皮肝穿刺活检及组织病理检查,评估肝纤维化分期(S0期、S1期、S2期、S3期、S4期),其中轻度组(S0~S1期)189例和中重度组(S2~S4期)286例。采用ELISA法检测血清GP73水平,应用FibroTouch无创肝脏检测系统测定肝脏硬度。比较2组血小板计数、肝脏硬度、血清GP73、HBV-DNA、乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)水平等指标。采用多因素logistic回归分析慢性HBV感染患者中重度肝纤维化的影响因素;绘制ROC曲线,评估血清GP73、肝脏硬度诊断慢性HBV感染患者中重度肝纤维化的效能。结果中重度组年龄[(36.47±9.30)岁]大于轻度组[(33.86±11.86)岁](t=2.677,P=0.008),直接胆红素[(4.50±3.25)μmol/L]、HBV-DNA[(4.66±1.32)lgu/mL]、HBsAg[(4.15±1.83)lgu/mL]、GP73[(86.25±31.37)μg/L]水平及肝脏硬度[(10.34±4.93)kPa]均高于轻度组[(3.85±2.65)μmol/L、(4.22±2.53)lgu/mL、(3.24±0.98)lgu/mL、(57.36±12.87)μg/L、(6.42±5.09)kPa](t=2.327、2.476、6.267、12.007、5.758,P均<0.05),血小板计数[(170.50±91.02)×10^(9)/L]低于轻度组[(196.00±57.89)×10^(9)/L](t=-3.030,P=0.003)。血小板计数(OR=0.964,95%CI:0.941~0.988,P=0.025)、血清GP73(OR=1.230,95%CI:1.074~1.424,P=0.003)、肝脏硬度(OR=1.349,95%CI:1.134~1.586,P=0.003)是慢性HBV感染患者中重度肝纤维化的影响因素。血清GP73、肝脏硬度分别以86.25μg/L、7.95 kPa为最佳截断值,诊断慢性HBV感染患者中重度肝纤维化的AUC分别为0.683(95%CI:0.668~0.698,P=0.005)、0.721(95%CI:0.710~0.732,P=0.001),灵敏度分别为46.6%、67.3%,特异度分别为81.2%、72.0%;血清GP73联合肝脏硬度诊断慢性HBV感染患者中重度肝纤维化的AUC为0.762(95%CI:0.751~0.773,P=0.001),灵敏度为5Objective To observe the changes of serum Golgi protein 73(GP73)level and liver stiffness in patients with chronic hepatitis B virus(HBV)infection at different stages of liver fibrosis,and to explore their values in assessing the progression of liver fibrosis.Methods Totally 475 patients with chronic HBV infection were diagnosed and treated in Henan Provincial People's Hospital from January 2018 to October 2019.All patients underwent percutaneous liver biopsy and histopathological examination to assess liver fibrosis stages(S0-S4),and were divided into mild group(S0-S1,n=189)and moderate to severe group(S2-S4,n=286).The serum GP73 level was detected by ELISA,and liver stiffness was assessed using the FibroTouch non-invasive liver assessment system.The platelet count,liver stiffness,and levels of serum GP73,HBV-DNA and hepatitis B surface antigen(HBsAg)were compared between two groups.Multivariate logistic regression analysis was performed to identify the factors influencing moderate to severe liver fibrosis in patients with chronic HBV infection.ROC curves were plotted to evaluate the diagnostic efficiencies of serum GP73 and liver stiffness on moderate to severe liver fibrosis.Results The patients were older in moderate to severe group[(36.47±9.30)years]than in mild group[(33.86±11.86)years](t=2.677,P=0.008).The direct bilirubin,HBV-DNA,HBsAg,GP73,and liver stiffness were higher in moderate to severe group[(4.50±3.25)μmol/L,(4.66±1.32)lgu/mL,(4.15±1.83)lgu/mL,(86.25±31.37)μg/L,(10.34±4.93)kPa]than those in mild group[(3.85±2.65)μmol/L,(4.22±2.53)lgu/mL,(3.24±0.98)lgu/mL,(57.36±12.87)μg/L,(6.42±5.09)kPa](t=2.327,2.476,6.267,12.007,5.758;all P values<0.05),and the platelet count was lower in moderate to severe group[(170.50±91.02)×10^(9)/L]than that in mild group[(196.00±57.89)×10^(9)/L](t=-3.030,P=0.003).The platelet count(OR=0.964,95%CI:0.941-0.988,P=0.025),serum GP73(OR=1.230,95%CI:1.074-1.424,P=0.003),and liver stiffness(OR=1.349,95%CI:1.134-1.586,P=0.003)were the influencing factors of mod

关 键 词：慢性乙型肝炎病毒感染 肝纤维化 高尔基体蛋白73 肝脏硬度 瞬时弹性成像 

分 类 号：R512.62[医药卫生—内科学]