慢性乙型肝炎病毒携带者血清GP73水平与肝组织病理学变化的关系研究

Forecasting hepatic activity index and liver fibrosis staging by serum golgiprotein-73 levels in individuals with chronic hepatitis B viral carriers

目的探讨慢性乙型肝炎病毒携带者血清高尔基体蛋白73(GP73)水平与肝组织病理学变化的关系。方法 2014年1月~2016年12月我院诊治的慢性HBV携带者150例、慢性乙型肝炎患者150例和乙型肝炎肝硬化患者150例,另选同期健康人50例,采用ELISA法检测GP73水平,对150例慢性HBV携带者进行肝穿刺活检,采用Metavir评分对肝组织炎症和纤维化进行评价。结果慢性HBV携带者血清GP73水平为(46.5±7.8)ng/ml,慢性乙型肝炎组为(90.2±10.9)ng/ml,乙型肝炎肝硬化组为(231.6±20.1)ng/ml,均显著高于健康人组的(36.7±6.6)ng/ml,差异有统计学意义(P<0.05),肝硬化患者血清GP73水平也显著高于慢性乙型肝炎或HBV携带者(P<0.05);经肝组织检查,150例慢性HBV携带者肝内炎症活动度分级和纤维化分期表现为G0~G1105例,G230例,G3~G415例,其血清GP73水平分别为(45.2±12.8)ng/ml、(63.8±15.0)ng/ml和(83.7±20.1)ng/ml,S0~S198例,S230例,S3~S422例,其血清GP73水平分别为(45.1±16.8)ng/ml、(67.3±16.4)ng/ml和(72.0±18.4)ng/ml,肝组织炎症活动度分级和纤维化分期严重的患者血清GP73水平显著升高,与分级或分期轻的人群比,差异有统计学意义(F=16.8,F=19.2,P均<0.05);Logistic回归分析发现血清GP73水平升高是慢性HBV携带者肝组织显著炎症(OR=1.1,95%CI:1.0~1.1,P<0.05)和显著肝纤维化(OR=2.1,95%CI:0.8~1.2,P<0.05)的高危因素。结论检测血清GP73水平可能有助于对慢性HBV携带者肝组织炎症分级和纤维化分期的判断,能否作为预测慢性HBV携带者肝组织炎症分级和纤维化分期的潜在标志物,还需要扩大验证。

Objective To forecast hepatic activity index and liver fibrosis staging by serum golgiprotein-73（GP73） levels in individuals with chronic hepatitis B viral carriers.Methods 150 individuals with chronic HBV carriers,150 patients with chronic hepatitis B,150 patients with hepatitis B liver cirrhosis and 50 healthy persons were recruited in this study between January 2014 and December 2016,and serum GP73 levels were detected by ELISA.Liver biopsies were performed in 150 individuals with chronic HBV carriers,and liver inflammation grading and fibrosis staging were evaluated by Metavir score.Results Serum GP73 level in patients with liver cirrhosis was（231.6±20.1） ng/ml,much higher than（46.5±7.8） ng/ml in chronic HBV carrier or（90.2±10.9） ng/ml in patients with chronic hepatitis B,and all of them were higher than（36.7±6.6） ng/ml in healthy persons（P〈0.05）;the liver biopsies in individuals with HBV carrier showed that G0～G1 were found in 105,G2 in 30 and G3～G4 in 15,and serum GP73 levels were（45.2±12.8）ng/ml,（63.8±15.0）ng/ml and（83.7±20.1）ng/ml,respectively,and S0 ～S1 in 98,S2 in 30 and S3～S4 in 22,and serum GP73 levels were（45.1 ±16.8）ng/ml,（67.3 ±16.4）ng/ml and（72.0 ±18.4）ng/ml,respectively,suggesting obviously increased serum GP73 levels in those with significant liver histopathologic inflammation grading and significant fibrosis staging（F =16.8,F =19.2,P 〈0.05）;Logistic regression analysis showed that increased serum GP73 level was an independent factor for significant hepatic inflammation（OR=1.1,95% confidence interval：1.0～1.1,P〈0.05） and for significant liver fibrosis（OR=2.1,95%CI：0.8 ～1.2,P 〈0.05）.Conclusion Serum GP73 level is associated with liver inflammation grade and fibrosis stage in chronic HBV carriers,which warrants further study to determine whether or not it might be acted as an potential marker for predicting liver inflammation and fibrosis.