慢性丙型肝炎患者血清N-寡糖和胆汁酸水平变化判断肝纤维化临床价值分析

Clinical evaluation of liver fibrosis by serum N-oligosaccharide and bile acid levels and liver stiffness measurement combination in patients with chronic hepatitis C

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.