血清指标在慢性乙型肝炎患者肝纤维化诊断中的应用价值

Application value of serum index in diagnosis of liver fibrosis in patients with chronic hepatitis B

目的探讨血清高尔基体跨膜糖蛋白73(GP73)、前胶原C端蛋白酶增强子1(PCPE-1)及Ⅲ型前胶原(PCⅢ)在慢性乙型肝炎(CHB)患者肝纤维化中的应用价值,以期为CHB患者肝纤维化的临床诊断提供参考。方法选取2018年4月—2021年2月周口市疾病预防控制中心专科病医院收治的150例CHB患者为研究对象,根据肝纤维化程度将其分为S1组(n=45)、S2组(n=57)、S3组(n=30)及S4组(n=18),并选择同期60名健康体检者为对照组。比较各组GP73、PCPE-1、PCⅢ水平,采用Spearman法分析CHB患者GP73、PCPE-1、PCⅢ水平与肝纤维化程度的相关性,根据受试者工作特征曲线(ROC)分析GP73、PCPE-1、PCⅢ及三者联合检测对患者肝纤维化的诊断价值。结果S1、S2、S3、S4组GP73、PCPE-1、PCⅢ水平明显高于对照组(P<0.05),S2、S3、S4组明显高于S1组(P<0.05),S3、S4组明显高于S2组(P<0.05),S4组明显高于S3组(P<0.05);经Spearman法分析表明,GP73、PCPE-1、PCⅢ与CHB患者肝纤维化程度呈正相关(r=0.719、0.700、0.688,P<0.05);GP73、PCPE-1、PCⅢ及三者联合诊断CHB患者肝纤维化的ROC曲线下面积(AUC)值分别为0.863、0.867、0.856、0.941,敏感度分别为69.33%、83.33%、76.67%、84.00%,特异度分别为96.67%、80.00%、88.33%、95.00%,且三者联合诊断AUC值明显高于三者单独诊断(P<0.05)。结论GP73、PCPE-1、PCⅢ在CHB中呈高表达,其水平与患者肝纤维化程度呈正相关,且三者联合检测在患者肝纤维化中的诊断价值较高。

Objective To explore the application value of serum Golgi transmembrane glycoprotein 73(GP73),procollagen C terminal protease enhancer 1(PCPE-1)and type III procollagen(PCⅢ)of liver fibrosis in patients with chronic hepatitis B(CHB),in order to provide reference for the clinical diagnosis of liver fibrosis in CHB patients.Methods A total of 150 CHB patients admitted to our hospital from Apr.2018 to Feb.2021 were selected as the study subjects,and they were divided into S1 group(n=45),S2 group(n=57),S3 group(n=30)and S4 group(n=18)according to the degree of liver fibrosis,60 healthy volunteers were selected in our hospital as the control group in the same period.The levels of GP73,PCPE-1,PCⅢin each group were compared,and Spearman method was used to analyze the correlation of the levels of GP73,PCPE-1,PCⅢwith the degree of liver fibrosis in CHB patients,the diagnostic value of GP73,PCPE-1,PCⅢand the combined detection of three indexes in liver fibrosis of patients was analyzed according receiver operating characteristic curve(ROC).Results The levels of GP73,PCPE-1 and PCⅢin S1,S2,S3 and S4 group were obviously higher than those in the control group(P<0.05),S2,S3 and S4 group were obviously higher than those in S1 group(P<0.05),S3 and S4 group were obviously higher than those in S2 group(P<0.05),and S4 group was obviously higher than that in S3 group(P<0.05);Spearman method analysis revealed that there was a positive correlation between the levels of GP73,PCPE-1,PCⅢand the degree of liver fibrosis in CHB patients(r=0.719,0.700,0.688,P<0.05);The value of area under the curve of ROC(AUC)of GP73,PCPE-1,PCⅢand the combined of three indexes diagnosis of liver fibrosis in CHB patients were 0.863,0.867,0.856,0.941 respectively,the sensitivity were 69.33%,83.33%,76.67%,84.00%respectively,the specificity were 96.67%,80.00%,88.33%,95.00%respectively,and the AUC value of the combined of three indexes was obviously higher than that of the independent of three indexes(P<0.05).Conclusion GP73,PCPE-1 and PCⅢwere highly expressed in CHB,and the levels of GP73,PCPE-1 and PCⅢwere positively correlated with the degree of liver fibrosis of patients,and the diagnostic value of the combined detection of the three indexes was higher of liver fibrosis of patients.