慢性乙型肝炎病毒感染相关肝病患者血清高尔基体蛋白73水平变化分析  

Serum GP73 variations in patients with liver disease associated with chronic hepatitis B virus infection

作　　者：王慧敏 谭炳芹[2,3] 王万鹏 吴梦雪[1] WANG Huimin;TAN Bingqin;WANG Wanpeng;WU Mengxue(School of Clinical Medicine,Shandong Second Medical University,Weifang 261053,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261053 [2]潍坊市人民医院感染性疾病科,山东潍坊261041 [3]山东第二医科大学第一附属医院感染性疾病科,山东潍坊261041

出　　处：《山东医药》2025年第1期100-103,108,共5页Shandong Medical Journal

基　　金：山东省潍坊市科技发展计划项目(2019YX050)。

摘　　要：目的探讨慢性乙型肝炎病毒(HBV)感染相关肝病患者血清高尔基体蛋白73(GP73)水平变化。方法选择慢性HBV感染者279例,其中慢性乙型肝炎(CHB)52例(CHB组)、肝硬化(LC)125例(LC组)、原发性肝癌(PHC)102例(PHC组),LC患者中代偿期乙型肝炎肝硬化(HBV-CC)27例(HBV-CC组)、失代偿期乙型肝炎肝硬化(HBV-DC)98例(HBV-DC组)。明确诊断后在抗病毒治疗前收集各组临床资料,用化学发光酶免疫分析法检测血清GP73。采用多因素二元Logistic回归分析GP73对PHC、HBV-DC发生的影响,绘制受试者工作特征(ROC)曲线评估GP73对PHC、HBV-DC的诊断价值。结果CHB组、LC组、PHC组血清GP73水平依次升高(P<0.05)。HBV-DC组血清GP73水平高于HBV-CC组(P<0.05)。GP73水平升高(OR=1.006,95%CI:1.001~1.011)、甲胎蛋白(AFP)水平升高(OR=1.021,95%CI:1.013~1.029)、异常凝血酶原(PIVKAⅡ)水平升高(OR=1.008,95%CI:1.003~1.012)是PHC发生的独立危险因素(P均<0.05)。根据多因素二元Logistic回归分析结果用GP73、AFP、和PIVKAⅡ构建PHC诊断模型(GAP模型),公式:logit(P)=0.006×GP73+0.021×AFP+0.007×PIVKAⅡ-4.103。GAP模型诊断PHC的曲线下面积高于GP73、AFP、PIVKAⅡ单独诊断的曲线下面积(P均<0.05)。GP73水平升高(OR=1.024,95%CI:1.011~1.036)、Hb水平降低(OR=0.932,95%CI:0.897~0.967)是HBV-DC发生的独立危险因素(P<0.05)。用GP73、Hb构建HBV-DC诊断模型(GH模型),公式:logit(P)=0.023×GP73-0.071×Hb+6.149。GH模型诊断HBV-DC的曲线下面积高于GP73、Hb单独诊断的曲线下面积(P均<0.05)。结论随着慢性HBV感染相关肝病进展血清GP73水平逐渐升高,血清GP73水平可提高其他指标对PHC、HBV-DC的诊断价值。Objective To investigate the changes in levels of serum golgi protein 73(GP73)in patients with liver diseases associated with chronic hepatitis B virus(HBV)infection.Methods We analyzed 279 chronic HBV-infected patients,including 52 cases of chronic hepatitis B(CHB group),125 cases of liver cirrhosis(LC group),and 102 cases of primary hepatocellular carcinoma(PHC group).Among LC cases,we classified 27 as HBV-related compensated cirrhosis(HBV-CC)and 98 as HBV-related decompensated cirrhosis(HBV-DC).We collected clinical data from each group after definitive diagnosis and prior to antiviral therapy,and measured serum GP73 levels by using chemiluminescent enzyme immunoassay.We used multivariate binary Logistic regression to analyze the effects of GP73 on PHC and HBV-DC.We plotted receiver operating characteristic(ROC)curves to assess the diagnostic value of GP73 for PHC and HBV-DC.Results Serum GP73 levels increased successively in the CHB group,LC group,and PHC group(all P<0.05).The serum GP73 level in the HBV-DC group was higher than that in the HBV-CC group(P<0.05).Elevated levels of GP73(OR=1.006,95%CI:1.001-1.011),alpha-fetoprotein(AFP)(OR=1.021,95%CI:1.013-1.029),and protein induced by vitamin K absenceⅡ(PIVKAⅡ)(OR=1.008,95%CI:1.003-1.012)were identified as independent risk factors for the development of PHC(all P<0.05).Based on the results of the multivariate binary Logistic regression analysis,we constructed a diagnostic model for PHC using GP73,AFP,and PIVKAⅡ(GAP model).The formula was as follows:logit(P)=0.006×GP73+0.021×AFP+0.007×PIVKAⅡ-4.103.We found that the area under the curve(AUC)of the GAP model in diagnosing PHC was significantly higher than that of GP73,AFP,or PIVKA-Ⅱalone(all P<0.05).The elevated GP73 level(OR=1.024,95%CI:1.011-1.036)and decreased hemoglobin(Hb)(OR=0.932,95%CI:0.897-0.967)levels were the independent risk factors for the occurrence of HBV-DC(both P<0.05).We constructed a diagnostic model for HBV-DC using GP73 and Hb(GH model).The formula was as follows:logit(P)=0.023�

关 键 词：肝炎 肝硬化 肝癌 高尔基体蛋白73 乙型肝炎病毒 

分 类 号：R575[医药卫生—消化系统]