血清CHI3L1、HA及超声弹性成像参数与慢性乙型肝炎患者发生显著性肝纤维化的关系  

The relationship between serum CHI3L1,HA,ultrasound elastomeric parameters and significant liver fibrosis in patients with chronic hepatitis B

作　　者：李静 王小华 于翠玲 谭烨 温赐祥 LI Jing;WANG Xiaohua;YU Cuiling;TAN Ye;WEN Cixiang(Department of Ultrasound Medicine,Zhuhai Integrated Traditional Chinese and Western Medicine Hospital,Zhuhai,Guangdong 519000,China)

机构地区：[1]珠海市中西医结合医院超声医学科,广东珠海519000

出　　处：《检验医学与临床》2025年第8期1055-1060,共6页Laboratory Medicine and Clinic

基　　金：2023年广东省珠海市社会发展领域科技计划项目(2320004000338)。

摘　　要：目的分析血清壳多糖3样蛋白1(CHI3L1)、透明质酸(HA)、超声弹性成像参数与慢性乙型肝炎(CHB)患者发生显著性肝纤维化的关系。方法选取2020年8月至2023年9月该院收治的190例CHB患者作为研究对象,根据是否为显著性肝纤维化,将患者分为观察组和对照组。采用超声仪获取超声弹性成像参数肝脏硬度值(LSM)、剪切波速度(Cs),采用酶联免疫吸附试验检测血清CHI3L1水平,采用免疫比浊法检测血清HA水平。采用Pearson相关分析观察组血清CHI3L1、HA水平及超声弹性成像参数与基于4因子的纤维化指数(FIB-4)、天冬氨酸转氨酶与血小板计数比值(APRI)的相关性。采用多因素Logistic回归分析CHB患者发生显著性肝纤维化的影响因素。绘制受试者工作特征(ROC)曲线分析血清CHI3L1、HA联合超声弹性成像参数对CHB患者发生显著性肝纤维化的预测价值。结果肝纤维化F0期9例,F1期74例,F2期54例,F3期43例,F4期10例。83例患者纳入对照组,107例患者纳入观察组。观察组FIB-4、APRI、血清CHI3L1、HA水平及LSM、Cs高于对照组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,观察组血清CHI3L1、HA水平及LSM、Cs与FIB-4、APRI均呈正相关(P<0.05)。多因素Logistic回归分析结果显示,血清CHI3L1、HA水平升高,LSM增大,Cs增快是CHB患者发生显著性肝纤维化的危险因素(P<0.05)。ROC曲线分析结果显示,4项指标联合预测的曲线下面积大于血清CHI3L1、HA、LSM、Cs单独预测(Z=3.942、3.705、3.597、3.481,P<0.05)。结论血清CHI3L1、HA联合超声弹性成像参数LSM、Cs对CHB患者发生显著性肝纤维化的预测价值较高,可为疾病预测提供可靠的依据。Objective To analyze the relationship between serum chitinase 3-like protein 1(CHI3L1),hyaluronic acid(HA),ultrasound elastomeric parameters and significant liver fibrosis in patients with chronic hepatitis B(CHB).Methods A total of 190 CHB patients admitted to the hospital from August 2020 to September 2023 were selected as the research subjects.According to whether they had significant liver fibrosis,the patients were divided into observation group and control group.Ultrasound was applied to obtain parameters such as liver stiffness value(LSM)and Cs,enzyme linked immunosorbent assay was applied to detect serum CHI3L1 level,immunoturbidimetry was applied to detect serum HA level.Pearson correlation analysis was applied to analyze the correlation between serum CHI3L1,HA levels,ultrasound elastography parameters and fibrosis index based on the 4 factor(FIB-4),aspartate aminotransferase to platelet ratio index(APRI)in the observation group.Multivariate Logistic regression analysis was applied to analyze the influencing factors of significant liver fibrosis in CHB patients.Receiver operating characteristic curve was plotted to analyze the diagnostic efficacy of serum CHI3L1,HA levels,and ultrasound elastography parameters for significant liver fibrosis in CHB patients.Results There were 9 cases of liver fibrosis in F0 stage,74 cases in F1 stage,54 cases in F2 stage,43 cases in F3 stage,and 10 cases in F4 stage.A total of 83 patients were included in the control group,and 107 patients were included in the observation group.The FIB-4,APRI,serum CHI3L1,HA levels,LSM and Cs in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The Pearson correlation analysis results showed that serum levels of CHI3L1,HA,LSM,Cs were positively correlated with FIB-4 and APRI in observation group(P<0.05).The results of multivariate Logistic regression analysis showed that elevated levels of serum CHI3L1 and HA,increased LSM,and accelerated Cs were risk factors for s

关 键 词：慢性乙型肝炎 肝纤维化 壳多糖3样蛋白1 透明质酸 超声弹性成像 

分 类 号：R512.6[医药卫生—内科学] R445.1[医药卫生—临床医学]