M-CSF血清水平与慢性HBV感染患者肝脏纤维化程度的相关性研究

The relationship between the serum level of macrophage colony stimulating factor and the liver fibrosis progression in patients with chronic hepatitis B virus infection

目的探讨巨噬细胞集落刺激因子(M-CSF)在慢性乙型肝炎病毒(HBV)感染患者肝纤维化进展过程中的表达水平差异及其对肝纤维化程度的无创诊断价值。方法选取175例行肝脏穿刺病理学检查的慢性HBV感染患者,并根据穿刺当日检测其相关临床指标计算出血清学诊断模型(FIB-4和APRI指数)的相应数值,采用Fibro Touch瞬时弹性检测仪检测患者肝脏硬度值(LSM),采用酶联免疫吸附方法检测19例健康对照及175例接受肝穿病理检查的慢性HBV感染患者外周血中M-CSF的表达水平。绘制M-CSF的受试者工作曲线,计算曲线下面积(AUC)、特异度和敏感度,并以肝穿病理结果为金标准,与FIB-4、APRI指数及LSM进行比较,评价M-CSF对肝纤维化程度的预测价值。结果无肝纤维化组(S0期及健康对照组)、轻中度肝纤维化组(S1~S2期)、重度肝纤维化组(S3~S4期)三组间M-CSF的表达差异有统计学意义(P<0.05)。其在不同炎症分组中亦差异有统计学意义(P<0.05)。M-CSF在诊断慢性HBV感染者发生肝纤维化(S≥1)的AUC为0.827,灵敏度和特异性分别为74.4%和80.0%,诊断早期肝硬化(S4)的AUC为0.627,灵敏度和特异度分别为59.7%和73.0%。结论M-CSF在慢性HBV感染患者中的表达水平随肝纤维化进展表达逐渐升高,在慢性HBV感染患者肝纤维化程度的无创诊断中有较好的临床价值。

Objective To explore the difference of the serum expression level of macrophage colony stimulating factor（ M-CSF） in chronic hepatitis B virus（ HBV） infection patients with different degrees of liver fibrosis and its non-invasive diagnosis value for liver fibrosis. Methods 175 patients with chronic HBV who underwent biopsy were selected into group. The routine laboratory indicators were detected to calculate the value of serological diagnosis model（ APRI and FIB-4 index）. The liver stiffness values（ LSM） were detected by Fibro Touch Transient elastography. The serum levels of M-CSF of 19 healthy control and 175 patients were measured by ELISA method. The diagnosis value of M-CSF,APRI,FIB-4 index and LSM for liver fibrosis were evaluated by the area under the receiver operating characteristic curves（ ROC）,the sensitivity and the specificity. Results The serum level of MCSF was significantly different among no fibrosis group（ S0 and healthy subject）,mild and advancen fibrosis group（ S1 ~ S2）,severe fibrosis group（ S3 - S4） statistically（ P 〈0. 05） and the serum level of M-CSF was also significantly different in all grades of inflammation（ P 〈0. 05）. The area under ROC curve（ AUC） of M-CSF for liver fibrosis（ S≥1） were 0. 827,the sensitivity and specificity were 74. 4% and 80. 0% respectively. The AUC of MCSF for early cirrhosis（ S4） were 0. 627,the sensitivity and specificity were 59. 7% and 73. 0%. Conclusion The serum level of M-CSF in patients with chronic HBV infection is gradually increased with the progression of liver fibrosis,it may offer an better possibility to evaluate the stage of fibrosis.