慢性肝病患者GGT/PLT比值与4项肝纤维化项目的相关性分析和对肝硬化的诊断意义

Correlation analysis between GGT/PLT ratio and four items of liver fibrosis in patients with chronic liver disease and its diagnostic significance for liver cirrhosis

目的初步探究慢性肝病患者γ-谷氨酰转移酶/血小板比值(GGT/PLT)和4项肝纤维化项目透明质酸酶(HA)、层黏连蛋白(LN)、Ⅲ型前胶原氨端肽(PⅢNP)、Ⅳ型胶原(Ⅳ-C)的相关性和对肝硬化诊断的比较。方法收集2018年10月至2020年1月慢性肝病患者263例,诊断为肝硬化的65例为实验组,其余患者198例为对照组,记录HA、LN、PⅢNP、Ⅳ-C、GGT和血小板(PLT),同时计算GGT/PLT比值(GPR);以同期年龄、性别匹配的健康体检人员21例设为观察组,实验组中再进一步选取符合Chid-Pugh分级标准的患者41例,收集GGT和PLT并计算GPR。结果慢性肝病患者HA、LN、Ⅳ-C、PⅢNP与GPR呈正相关关系,相关系数分别为0.67、0.56、0.73、0.48(P<0.05),匹配前后实验组GPR、HA、LN、Ⅳ-C、PⅢNP水平分别高于对照组GPR、HA、LN、Ⅳ-C、PⅢNP,GPR、HA、LN、Ⅳ-C、PⅢNP对肝硬化的ROC曲线下面积(AUC)分别为0.80、0.82、0.77、0.83、0.73,且GPR的AUC与HA、LN、Ⅳ-C相比差异无统计学意义(P>0.05),大于PⅢNP的AUC(P<0.05),GPR的最大约登指数为1.10(灵敏度为0.71,特异度为0.80);观察组GPR(0.18±0.07)低于对照组GPR(0.95±0.76),肝功能分级A级GPR(1.01±1.32)低于B级GPR(2.82±2.46),肝功能分级B级GPR(2.82±2.46)低于C级GPR(8.49±4.03)。结论GGT/PLT比值和4项肝纤维化项目两者水平呈正相关关系,增高反映了肝纤维化,对肝硬化诊断性能接近,有望成为肝硬化防治上4项肝纤维化项目的替代物,其临床应用有待进一步的研究。

Objective To preliminarily study the correlation between 4 liver fibrosis items:hyaluroni acid(HA),laminin(LN),typeⅢprocollagen N-terminal peptide(PⅢNP),type IV collagen(IV-C)and gamma-glutamyl-transpeptidase-to-platele ratio(GGT/PLT)in patients with chronic liver disease.Methods A total of 263 patients with chronic liver disease from November 2018 to January 2020 were collected.65 patients diagnosed with liver cirrhosis were the experimental group,and the remaining 198 patients were the control group.HA,LN,PⅢNP,IV-C,GGT and PLT were recorded,and the GGT/PLT ratio(GPR)was calculated.In the same period,21 healthy people with age and gender matching were selected as the observation group.In the experimental group,41 patients who met Chid-Pugh classification criteria were further selected,simultaneously collect GGT and PLT and calculate the GGT/PLT ratio(GPR).Results In patients with chronic liver disease,HA,LN,Ⅳ-C,PⅢNP were positively correlated with GPR,and the correlation coefficients were 0.67,0.56,0.73,0.48 respectively,the difference was statistically significant(P<0.05).The GPR,HA,LN,IV-C,PⅢNP levels of the experimental group were higher than the GPR,HA,LN,Ⅳ-C,PⅢNP of the control group before and after matching.The area under the ROC curve(AUC)of GPR,HA,LN,Ⅳ-C,and PⅢNP to liver cirrhosis were 0.80,0.82,0.77,0.83,0.73 respectively.And the AUC of GPR was not significantly different from HA,LN,Ⅳ-C,the difference was not statistically significant(P>0.05),which is greater than that of PⅢNP,the difference was statistically significant(P<0.05).The optimal GPR cut-off was 1.10(sensitivity 0.71,specificity 0.80).The GPR of the observation group(0.18±0.07)is lower than the GPR of the control group(0.95±0.76).The level of GPR(1.01±1.32)in liver function class A is lower than GPR(2.82±2.46)in class B.The level of GPR(2.82±2.46)in liver function class B is lower than GPR(8.49±4.03)in class C.Conclusion The GGT/PLT ratio is positively correlated with the level of 4 liver fibrosis projects,whose increase reflects liver fibrosis and has similar diagnostic performance for liver cirrhosis.It is expected to be a substitute for 4 liver fibrosis projects in the diagnosis and treatment of liver cirrhosis,and its clinical application needs further study.