血清甲胎蛋白评估慢性乙型肝炎患者肝脏显著炎症的临床应用

Clinical application of serum alpha fetoprotein for assessment of liver significant inflammation in patients with chronic hepatitis B

目的探讨血清甲胎蛋白(AFP)在评估慢性乙型肝炎(CHB)患者肝脏显著炎症(炎症活动度G≥2)的临床应用价值。方法选取165例CHB患者为研究对象,分为3组:G0/1组77例、G2组56例、G3/4组32例,分析各组血清甲胎蛋白(AFP)、白蛋白(ALB)、球蛋白(GLB)、总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)和γ-谷氨酰转肽酶(γ-GGT)等肝功能指标。各组均数比较采用Mann-whitney和Kruskal-Wallis检验,二项多元Logistic回归分析患者各指标与肝脏炎症关系,同时运用Spearman相关分析AFP与ALB、GLB、ALT、AST、ALP、γ-GGT和TBIL等肝功能指标的相关系数,以受试者工作特征曲线(ROC)评估AFP、ALT、AST和γ-GGT在诊断肝脏显著炎症的敏感性和特异性。结果 G0/1组AFP含量为1.64(1.28~1.86)ng/ml,G2组为4.27(2.69~9.45)ng/ml,G3/4组为7.83(3.72~14.28)ng/ml,3组间AFP含量差异有统计学意义(P<0.001)。CHB患者血清AFP含量与GLB、TBIL、ALT、AST、ALP和γ-GGT等指标均呈正相关性(ρ分别为0.291、0.261、0.310、0.538、0.253、0.546,P均<0.001),而与ALB呈负相关性(ρ=-0.278,P<0.001)。血清AFP含量是CHB患者肝脏显著炎症的独立预测因素(P<0.001,95%可信区间:1.415~2.692)。当AFP、ALT、AST和γ-GGT指标在评估CHB肝脏显著炎症时,AFP曲线下面积最大(0.923),其cut-off值为2.08 ng/ml,敏感性、特异性分别为89.8%和88.3%。结论血清AFP在评估肝脏显著炎症的CHB患者具有重要的临床诊断价值。

Objective To explore the clinical application of serum alpha fetoprotein(AFP) for assessment of liver significant inflammation(inflammation activity G≥2) in patients with chronic hepatitis B(CHB). Methods 165 patients with chronic hepatitis B were selected from the Second Affiliated Hospital of Anhui Medical University, and divided into three groups: 77 patients in G0/1 group, 56 patients in G2 group and 32 patients in G3/4 group. Serum AFP level and liver function indexes were determined by clinical laboratory instruments. The means comparison among groups were analyzed by Mann-whitney or Kruskal-Wallis test. The relations between above-mentioned indexes and liver inflammation binary was analyzed by using multivariate Logistic regression. The correlation coefficient of AFP, albumin(ALB), globulin(GLB), alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyl-transferase(γ-GGT) and total bilirubin(TBIL) was analyzed by Spearman. Moreover, receiver operating characteristic curve(ROC) was used to evaluate the sensitivity and specificity of AFP, ALT, AST, ALP and γ-GGT in diagnosis of liver significant inflammation. Results Serum AFP level was 1.64(1.28~1.86) ng/ml in G0/1 group, 4.27(2.69~9.45) ng/ml in G2 group, and 7.83(3.72~14.28) ng/ml in G3/4 group. The differences of serum AFP levels in three groups were significant(P<0.001). Serum AFP level of CHB patients was positive correlated with GLB, TBIL, ALT, AST, ALP and γ-GGT(ρ was 0.291, 0.261, 0.310, 0.538, 0.253 and 0.546, respectively, P all <0.001), while negative correlated with ALB(ρ=-0.278,P<0.001). AFP was found to be an independent predictive factor of CHB patients with liver significant inflammation(P<0.001, 95% confidence interval: 1.415~2.692). ROC curve analysis showed that the area under the curve of AFP was the largest(0.923). The cut-off value of AFP was 2.08 ng/ml, with a sensitivity of 89.8%, specificity of 88.3%. Conclusion Serum AFP is a valuable diagnostic marker for CHB patients with liver significant inflammation.