摘要
目的探讨应用血清N-寡糖、总胆汁酸(TBA)联合肝脏硬度检测(LSM)评估慢性丙型肝炎(CHC)患者肝纤维化的临床价值。方法2018年6月~2021年6月我院收治的CHC患者84例和健康体检者51例。使用全自动生化分析仪检测血清TBA水平,应用测序仪及其数据分析软件检测血清N-寡糖相对含量,使用Fibroscan-502检测LSM值。应用受试者工作特征曲线(ROC)计算曲线下面积(AUC),评价联合检测的诊断价值。结果CHC组血清N-寡糖和TBA水平分别为(4.1±0.8)和(20.0±3.1)μmol/L,显著高于对照组【分别为(1.6±0.3)和(8.6±1.5)μmol/L,LSM值为(16.7±2.9)kPa,显著大于对照组【(6.3±0.4)kPa,P<0.05】;肝组织学检查发现,肝纤维化S_(1)期19例、S_(2)期21例、S_(3)期26例和S_(4)期18例;S_(1)期、S_(2)期、S_(3)期和S_(4)期患者血清N-寡糖分别为(2.5±0.6)、(3.8±0.7)、(4.3±0.7)和(5.7±1.0),血清TBA水平分别为(11.3±2.5)μmol/L、(18.5±3.1)μmol/L、(21.4±3.7)μmol/L和(28.7±4.1)μmol/L,LSM值为分别为(6.3±1.7)kPa、(13.8±2.1)kPa、(17.9±3.2)kPa和(29.4±4.6)kPa,提示随肝纤维化程度的升高各指标也升高(P<0.05);联合检测评估CHC患者进展期肝纤维化的AUC为0.918(95%CI:0.862~0.973,Se为90.9%,Sp为77.5%,Ac为84.5%),显著大于血清N-寡糖【0.785(95%CI:0.675~0.894),Se为93.2%,Sp为67.5%,Ac为81.0%】、TBA【0.769(95%CI:0.668~0.870),Se为68.2%,Sp为77.5%,Ac为72.6%】或LSM值【0.802(95%CI:0.708~0.895),Se为75.0%,Sp为80.0%,Ac为77.4%】等单项检测(P<0.05)。结论应用血清N-寡糖、TBA联合LSM评估CHC患者肝纤维化程度具有一定的临床价值,值得进一步研究。
Objective The aim of this study was to explore the clinical evaluation of liver fibrosis(LF)by serum N-oligosaccharide and total bile acid(TBA)levels and liver stiffness measurement(LSM)combination in patients with chronic hepatitis C(CHC).Methods A total of 84 patients with CHC and 51 healthy individuals were enrolled in our hospital between June 2018 and June 2021.Serum TBA levels were detected by full-automatic biochemical analyzer.The relative content of serum N-oligosaccharide was detected and calculated with data analysis software.The LSM was detected by Fibroscan-502.The diagnostic value of combined parameters was evaluated by area under the receiver operating characteristic(ROC)curve(AUC).Results Serum N-oligosaccharide and TBA levels in patients with CHC were(4.1±0.8)and(20.0±3.1)μmol/L,significantly higher than[(1.6±0.3)and(8.6±1.5)μmol/L,and the LSM was(16.7±2.9)kPa,significantly higher than[(6.3±0.4)kPa,P<0.05]in the control;the liver histopathological examination showed LF S_(1) in 19 cases,S_(2) in 21 cases,S_(3) in 26 cases and S_(4) in 18 cases;serum N-oligosaccharide levels in patients with S_(1),S_(2),S_(3) and S_(4) were(2.5±0.6),(3.8±0.7),(4.3±0.7)and(5.7±1.0),serum TBA levels were(11.3±2.5)μmol/L,(18.5±3.1)μmol/L,(21.4±3.7)μmol/L and(28.7±4.1)μmol/L,and the LSM were(6.3±1.7)kPa,(13.8±2.1)kPa,(17.9±3.2)kPa and(29.4±4.6)kPa,suggesting they increased as the LF severer(P<0.05);the AUC by the three parameter combination in predicting LF was 0.918(95%CI:0.862-0.973,with Se of 90.9%,Sp of 77.5%and Ac of 84.5%),significantly higher than[0.785(95%CI:0.675-0.894),with Se of 93.2%,Sp of 67.5%and Ac of 81.0%]by serum N-oligosaccharide levels,or[0.769(95%CI:0.668-0.870),with Se of 68.2%,Sp of 77.5%and Ac of 72.6%]by serum TBA levels or[0.802(95%CI:0.708-0.895),with Se of 75.0%,Sp of 80.0%and Ac of 77.4%]by LSM alone(P<0.05).Conclusion The combination of serum N-oligosaccharides and TBA levels as well as LSM is of evaluation value for severity of liver fibrosis in patients with CHC,which needs further investigation.
作者
罗真真
田海英
葛建华
纪元
Luo Zhenzhen;Tian Haiying;Ge Jianhua(Clinical Laboratory,Second Affiliated Hospital,Shandong First Medical University,Tai’an 271000,Shandong Province,China)
出处
《实用肝脏病杂志》
CAS
2022年第4期504-507,共4页
Journal of Practical Hepatology
基金
山东省自然科学基金资助项目(编号:ZR2019HP16)。
关键词
慢性丙型肝炎
N-寡糖
胆汁酸
肝脏硬度检测
肝纤维化
诊断
Hepatitis C
N-oligosaccharide
Bile acid
Liver stiffness measurement
Liver fibrosis
Diagnosis