脂蛋白相关磷脂酶A2与乙肝肝硬化Child-Pugh分级

Relationship between Lp-PLA2 and Child-Pugh classification in patients with hepatitis B cirrhosis

目的探讨血清脂蛋白相关磷脂酶A2(lipoprotein related phospholipase A2,Lp-PLA2)水平与乙型肝炎肝硬化Child-Pugh分级的关系.方法选择269例乙型肝炎肝硬化患者为病例组,慢性乙型肝炎(chronic hepatitis B, CHB)组157例为疾病对照组,健康体检者120例为正常组,肝硬化患者根据ChildPugh分级分为A、B、C组进行,各组均抽取静脉血采用免疫散射比浊法检测其血清Lp-PLA2水平,采用倾向性评分匹配统计学分析进行筛选,根据匹配结果对应的分组进行统计分析,比较各组间的差异.结果肝硬化C组血清Lp-PLA2水平(443.1 ng/mL±40.6ng/mL)明显高于肝硬化A组(208.5ng/mL±84.6ng/mL)、B组(390.5 ng/mL±42.3 ng/mL)和CHB组(154.3ng/mL±54.1ng/mL)(P <0.01),肝硬化B组明显高于肝硬化A组和CHB组(P<0.01),肝硬化A组明显高于CHB组(P <0.01),CHB组与健康对照组(119.1ng/mL±19.8 ng/mL)相比差异显著(P<0.01); ROC曲线显示:当对照组设为CHB对肝硬化的AUC为0.852,诊断阈值为262.5 ng/mL;对照组设为硬化A级对肝硬化B级的AUC为0.969,诊断阈值为311.5 ng/mL;对照组设为硬化B级对24例肝硬化C级的AUC为0.809,诊断阈值为420.5 ng/mL.结论血清Lp-PLA2水平随乙型肝炎肝硬化的病程进展呈升高趋势,有助于肝硬化Child-Pugh分级的判断,血清Lp-PLA2水平的变化可作为乙型肝炎肝硬化病程监测的参考指标.

AIM To investigate the association between serum lipoprotein related phospholipase A2(Lp-PLA2)level and Child-Pugh classification in patients with hepatitis B cirrhosis.METHODS A total of 269 patients with hepatitis B cirrhosis were selected as a case group,157 patients with chronic hepatitis B selected as a disease control group,and 120 healthy subjects as a normal control group.Cirrhotic patients were divided into groups A,B,and C according to Child-Pugh classification.The venous blood was collected from each group and serum Lp-PLA2 level was detected by immunoturbidimetry.After propensity score matching(PSM),statistical analysis was performed to compare serum Lp-PLA2 levels between different groups.RESULTS The level of serum Lp-PLA2 was significantly higher in the liver cirrhosis group C(443.1 ng/mL±40.6 ng/mL)than in the liver cirrhosis groups A(208.5 ng/mL±84.6 ng/mL)and B(390.5 ng/mL±42.3 ng/mL)and the chronic hepatitis B group(154.3 ng/mL±54.1 ng/mL)(P<0.01),in the liver cirrhosis group B than in the liver cirrhosis group A and the chronic hepatitis B group(P<0.01),and in the liver cirrhosis group A than in the liver chronic hepatitis B group(P<0.01).Similar results were also found between the chronic hepatitis B group and the healthy control group(119.1 ng/mL±19.8 ng/mL)(P<0.01).The ROC curve showed that when chronic hepatitis B was used as the control group,the area under the ROC curve of liver cirrhosis was 0.852,and the diagnostic threshold was 262.5 ng/mL.When cirrhosis grade A was used as the control group,the area under the ROC curve of cirrhosis grade B was 0.969,and the diagnostic threshold was 311.5 ng/mL.When cirrhosis grade B was used as the control group,the area under the ROC curve of cirrhosis grade C was 0.809,and the diagnostic threshold was 420.5 ng/mL.CONCLUSION The level of serum Lp-PLA2 increases with the progression of hepatitis B cirrhosis,which is helpful for judging the Child-Pugh classification of patients with hepatitis B cirrhosis.Serum Lp-PLA2 level can be used as a reference index for monitoring the course of hepatitis B cirrhosis.