肝纤维化指标、TIMP-1在慢性乙型肝炎纤维化中的诊断效能及与肝硬化的关联性分析

Analysis of liver fibrosis indicators,TIMP-1 in the diagnosis of chronic hepatitis B fibrosis and their correlation with liver cirrhosis

目的探讨肝纤维化指标、基质金属蛋白酶抑制因子-1(TIMP-1)在慢性乙型肝炎纤维化中的诊断效能及与肝硬化的关联性。方法选取2017年2月至2019年6月广东省农垦中心医院收治的慢性乙型肝炎纤维化患者119例设为研究组、同期体检健康者119例设为对照组。入院后抽取两组受检者空腹外周静脉血,经酶促化学发光免疫分析法测定肝纤维化指标[血清Ⅳ型胶原(CⅣ)、Ⅲ型前胶原氨基端肽(PⅢP)、层粘连蛋白(LN)、透明质酸(HA)]水平,酶联免疫吸附法(ELISA)测定血清TIMP-1水平。统计两组及不同肝硬化程度(代偿期、失代偿期)患者血清肝纤维化指标、TIMP-1水平,并分析血清肝纤维化指标、TIMP-1诊断效能及其与肝硬化间的关系。结果研究组血清CⅣ、PⅢP、LN、HA、TIMP-1水平高于对照组(P<0.05);失代偿期肝硬化患者血清CⅣ、PⅢP、LN、HA、TIMP-1水平高于代偿期肝硬化患者(P<0.05);经Pearson相关性分析可知,血清CⅣ(r=0.793)、PⅢP(r=0.783)、LN(r=0.765)、HA(r=0.812)、TIMP-1(r=0.803)水平与肝硬化程度间存在正相关关系(P<0.05);血清肝纤维化指标联合TIMP-1诊断肝硬化灵敏度97.48%、准确度96.22%,高于肝纤维化指标(87.39%、92.44%)、TIMP-1(83.19%、89.50%)单独诊断(P<0.05);联合诊断特异度(94.96%)与肝纤维化指标(97.48%)、TIMP-1(95.80%)单独诊断比较,差异无统计学意义(P>0.05)。结论肝纤维化指标、TIMP-1在慢性乙型肝炎纤维化患者中呈异常高表达状态,联合检测可显著提高诊断灵敏度、准确度,不影响诊断特异度,且与肝硬化呈正相关。

Objective To investigate the diagnostic efficacy of liver fibrosis indicators and matrix metalloproteinase inhibitor-1(TIMP-1)in chronic hepatitis B fibrosis and its association with cirrhosis.Methods A total of 119 patients with chronic hepatitis B fibrosis admitted to Guangdong Provincial Agricultural Reclamation Central Hospital from February 2017 to June 2019 were selected as the study group,and 119 healthy patients with physical examination during the same period were selected as the control group.After admission,fasting peripheral venous blood samples were drawn from the two groups of subjects,and the levels of hepatic fibrosis indicators[serum typeⅣcollagen(CⅣ),typeⅢprocollagen amino terminal peptide(PⅢP),laminar adhesion protein(LN),hyaluronic acid(HA)]were determined by enzymatic chemiluminescence immunoassay method.The differences of serum liver fibrosis indicators and TIMP-1 levels between the two groups were analyzed,and patients with different degrees of liver cirrhosis(compensation period,decompensation period)in the study group were also analyzed.The serum liver fibrosis indicators,TIMP-1 diagnostic efficacy and thier relationship with liver cirrhosis were analyzed.Results The levels of serum CⅣ,PⅢP,LN,HA and TIMP-1 in the study group were higher than those in the control group(P<0.05).The levels of serum CⅣ,PⅢP,LN,HA and TIMP-1 in patients with decompensated cirrhosis were higher than those in the compensated cirrhosis(P<0.05);Pearson correlation analysis showed that there was a significant positive correlation between the levels of serum CⅣ(r=0.793),PⅢP(r=0.783),LN(r=0.765),HA(r=0.812),TIMP-1(r=0.803)and the degree of liver cirrhosis(P<0.05).The diagnostic sensitivity and accuracy of serum liver fibrosis index combined with TIMP-1 were 97.48%and 96.22%,respectively,which were higher than that of the liver fibrosis inclicators(87.39%,92.44%),TIMP-1(83.19%,89.50%)alone(P<0.05),and the combined diagnostic specificity(94.86%)was not statistically significant different from liver fibrosis inclicators(97.98%)and TIMP-1(95.80%)alone(P>0.05).Conclusion The liver fibrosis indicators and TIMP-1 are abnormally high in patients with chronic hepatitis B.Detection of liver fibrosis inclicators combined with TIMP-1 can significantly improve the sensitivity and accuracy without affecting the specificity of diagnosis.They are positively correlated with liver cirrhosis.