肝纤四项在乙型肝炎肝纤维化及肝硬化患者中的诊断价值

Diagnostic Value of HA,LN,CIV and PⅢNP in Patients With Liver Fibrosis and Cirrhosis of Hepatitis B

目的探讨肝纤四项,包括Ⅲ型前胶原(procollagen Ⅲ n-terminal peptide,PⅢNP),Ⅳ型胶原(collagenⅣ,CIV),透明质酸酶(hyaluronic acid,HA)及层黏连蛋白(laminin,LN)在慢性乙型病毒性肝炎(chronic viral hepatitis B,CHB)肝纤维化及肝硬化中的诊断价值。方法回顾性分析2016年1月—2021年5月作者医院323例CHB患者肝穿病理组织学检查结果及肝纤四项报告数据,分析PⅢNP、CIV、HA、LN、在诊断不同程度肝纤维化的受试者工作曲线下的面积(AUC),评估PⅢNP、CIV、HA、LN在CHB患者肝纤维化及肝硬化的诊断价值。结果PⅢNP、CIV、HA及LN在CHB不同程度肝纤维化及肝硬化患者的检测结果差异有统计学意义(P<0.001)。(1)在诊断明显肝纤维化(S≥2)中PⅢNP、CIV、HA及LN的AUC分别为0.764、0.761、0.718、0.724,最佳分界值分别为14.0 ng/mL、50.0 ng/mL、l54.3 ng/mL、35.0 ng/mL,对应的灵敏度/特异度分别为58.06%/86.79%、69.59%/71.70%、58.06%/75.47%、61.75%/71.70%。(2)在诊断肝硬化(S4)中PⅢNP、CIV、HA及LN的AUC分别为0.736、0.895、0.837、0.698,最佳分界值分别为21.3 ng/mL、109.0 ng/mL、103.3 ng/mL、56.0 ng/mL,对应灵敏度/特异度分别为51.28%/84.86%、79.49%/88.73%、74.36%/86.97%、56.41%/79.58%。结论PⅢNP、CIV、HA及LN可用于CHB肝纤维化及肝硬化患者的 临床辅助诊断。

Objective To analyze the diagnostic value of PⅢNP,CIV,HA and LN in liver fibrosis and cirrhosis of chronic hepatitis B.Methods Review analysis the results of liver biopsy and PⅢNP,CIV,HA and LN in 323 CHB patients from January 2016 to May 2021.Analyze the AUC of PⅢNP,CIV,HA and LN in the diagnosis of different degrees of liver fibrosis.Evaluate the diagnostic value of PⅢNP,CIV,HA and LN in the diagnosis of liver fibrosis and cirrhosis.Results The results of PⅢNP,CIV,HA and LN were statistically significant in different degrees of liver fibrosis(P<0.001),the AUC was 0.764,0.761,0.718,0.724 in the diagnosis of obvious liver fibrosis(S≥2),respectively.The optimal cut-off value was 14.0 ng/mL,50.0 ng/mL,l54.3 ng/mL,35.0 ng/mL,corresponding to 58.06%/86.79%,69.59%/71.70%,58.06%/75.47%,61.75%/71.70% sensitivity/specificity.AUC of cirrhosis was 0.736,0.895,0.837,0.698 respectively.The optimal cut-off values were 21.3 ng/mL、109.0 ng/mL、103.3 ng/mL、56 ng/mL corresponding sensitivity/specificity of 51.28%/84.86%,79.49%/88.73%,74.36%/86.97%,56.41%/79.58%.Conclusion PⅢNP,CIV,HA and LN have diagnostic value in the diagnosis of liver fibrosis and cirrhosis of hepatitis B,and can be used in clinical auxiliary diagnosis.