血清壳多糖酶3样蛋白1和甲胎蛋白联合检测对不同肝脏疾病的诊断价值

The diagnostic value of combined detection of serum chitinase 3-like protein 1 and alpha-fetoprotein for different liver diseases

目的评估血清壳多糖酶3样蛋白1(CHI3L1)和甲胎蛋白(AFP)联合检测对不同肝脏疾病的临床诊断价值。方法将147例乙肝病毒感染患者分为正常组(36例)、肝纤维化组(43例)、肝硬化组(38例)、肝癌组(30例),对四组患者分别采取AFP、CHI3L1单独与联合检测,评估不同检测方法对不同肝脏疾病的阳性率、ROC曲线下面积、敏感性与特异性。结果与正常组相比,肝纤维化组、肝硬化组、肝癌组的AFP、CHI3L1指标均升高,其中肝癌组AFP水平高于肝纤维化组与肝硬化组,CHI3L1水平随着疾病的加重而升高(P<0.05);AFP+CHI3L1联合检测对不同肝脏疾病的阳性率高于AFP、CHI3L1单独检测的阳性率(P<0.05);在肝纤维化组中,AFP+CHI3L1联合检测的AUC值优于AFP(P<0.05),但与CHI3L1检测差异无统计学意义(P>0.05);在肝硬化组和肝癌组,AFP+CHI3L1联合检测的AUC值优于CHI3L1(P<0.05),但与AFP检测差异无统计学意义(P>0.05)。结论AFP与CHI3L1联合检测对不同肝脏疾病的诊断效能要略优于AFP单项检测,而CHI3L1在鉴别不同肝脏疾病的临床诊断价值方面有待于进一步的研究。

Objective To evaluate the clinical diagnostic value of combined detection of serum chitinase-like protein1(CHI3L1)and alpha-fetoprotein(AFP)for different liver diseases.Methods We divided 147 patients with hepatitis B virus infection into healthy group(n=36),liver fibrosis group(n=43),liver cirrhosis group(n=38)and liver cancer group(n=30).AFP and CHI3L1 were measured alone and jointly for the four groups.The positive rate of different test methods for different liver diseases,the area under the ROC curve,and sensitivity and specificity were evaluated.Results Compared with the healthy group,AFP and CHI3L1 in the liver fibrosis group,the liver cirrhosis group and the liver cancer group were all increased.The AFP level of the liver cancer group was higher than that of the liver fibrosis group and the cirrhosis group,and CHI3L1 level was increased as the disease worsens(P<0.05).The positive rate of the combined detection for different liver diseases was higher than that of AFP or CHI3L1 alone(P<0.05).In the hepatic fibrosis group,the combined detection was significantly better than AFP alone(P<0.05),but there was no significant difference when compared with CHI3L1 detection alone(P>0.05).In the cirrhosis group and liver cancer group,the combined detection was significantly better than CHI3L1 alone(P<0.05),but there was no significantly different from AFP detection alone(P>0.05).Conclusion The combined detection of AFP and CHI3L1 is better than AFP single test for the diagnosis of different liver diseases,and CHI3L1 needs further researches to prove its clinical diagnostic value for different liver diseases.