血清壳多糖酶3样蛋白Ⅰ检测在诊断乙肝肝硬化患者的临床价值

Clinical Efficacy of Serum Chitinase 3 like Protein I in the Diagnosis of Patients with Hepatitis B Cirrhosis

目的:探究血清壳多糖酶3样蛋白I(chitinase 3 like protein I,CHI3LI)在乙肝肝硬化患者诊断中的临床价值。方法:选取宜春市第二人民医院收治的乙肝肝病患者106例,根据肝脏生化指标、影像学和组织病理学检查,将其分为肝炎组和肝硬化组,并同步随机选择50例健康体检者作为健康对照组。采用酶联免疫吸附法定量检测血清CHI3LI水平,肝穿刺病理分析肝纤维分期,FibroScan方法测定肝脏弹性值(LSM)。比较三组血清CHI3LI水平,分析不同纤维分期CHI3LI水平和LSM,评估血清CHI3LI水平对乙肝肝硬化的诊断效能。结果:肝硬化组CHI3LI水平显著高于肝炎组和健康对照组,差异有统计学意义(P<0.05)。肝穿刺活检结果显示,血清CHI3LI水平对肝纤维化S0-S1和S2/S3/S4期之间的差异可以显著区分,而LSM仅能在肝纤维化达到S4期时才能进行区分。ROC曲线分析结果显示,血清CHI3LI从健康人群中辨别诊断乙肝肝硬化的曲线下面积(AUC)为0.935,阈值为78.16 ng/mL时,灵敏度为80.5%,特异度为100%,血清CHI3LI从肝炎人群中辨别诊断乙肝肝硬化的曲线下面积AUC为0.802,阈值为83.8 ng/mL时,灵敏度为78%,特异度为77%。结论:血清CHI3LI水平在判断与预测乙肝患者肝纤维化水平和发展趋势方面具有很大潜力,在肝硬化预测与诊断方面具有良好的临床价值。

Objective:To explore the clinical value of serum chitinase 3 like protein I(CHI3LI)in the diagnosis of hepatitis B cirrhosis.Methods:106 patients with hepatitis B liver disease admitted to the Second People’s Hospital of Yichun City were selected and divided into two groups,hepatitis group and cirrhosis group,based on liver biochemical indexes,imaging and histopathological examination.50 cases of the same period of healthy physical examination were also selected as healthy control group.The level of serum CHI3LI was determine by Enzyme linked immunosorbent assay.Liver fiber stage and liver elasticity value(LSM)were respectively examined by hepatic puncture pathology and FibroScan.Serum CHI3LI levels were compared among the three groups,and CHI3LI levels and LSM were analyzed at different fiber stages to evaluate the diagnostic efficacy of serum CHI3LI levels for hepatitis B cirrhosis.Diagnostic efficacy of serum CHI3LI level in hepatitis B cirrhosis was estimated from analysis of CHI3LI levels and LSM in different fiber stages and CHI3LI level difference among Chronic hepatitis B,hepatitis B cirrhosis and control group.Results:CHI3LI levels of cirrhosis group were significantly higher(p<0.05)than the hepatitis group and the healthy control group.The results of liver puncture biopsy analysis showed that serum CHI3LI levels could significantly differentiate the difference between stages S0/S1 and S2/S3/S4 of liver fibrosis,whereas LSM could only differentiate when liver fibrosis reached stage S4.The results of ROC curve analysis showed that the area under the curve(AUC)for the differential diagnosis of cirrhosis of hepatitis B by serum CHI3LI from the healthy population was 0.935,the threshold was 78.16 ng/mL,the sensitivity was 80.5%and specificity was 100%.The area under the curve(AUC)of serum CHI3LI for the differential diagnosis of hepatitis B cirrhosis from a hepatitis population was 0.802,the sensitivity was 78%and specificity was 77%at a threshold value of 83.8 ng/mL.Conclusion:Serum CHI3LI levels have great potential in determining and predicting the level and trend of liver fibrosis in hepatitis B patients.It has also good clinical value in the prediction and diagnosis of liver cirrhosis.