微小RNA检测在鉴别HBV慢性感染和HBV相关性肝癌中的应用

Value of microRNA in differential diagnosis of chronic HBV infection and HBV-related liver cancer

目的 分析微小RNA(miRNA)-181a、miR-21和miR-92a检测在鉴别乙型肝炎病毒(HBV)慢性感染和HBV相关性肝癌中的应用价值。方法 选取2017年12月-2020年12月于西南医科大学附属医院确诊的54例HBV相关性肝癌患者为肝癌组,选取同期确诊的54例慢性乙型肝炎(CHB)患者为CHB组,54例HBV相关性肝硬化患者纳入肝硬化组。检测患者肝功能指标,包括天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、谷酰转肽酶(GGT)和碱性磷酸酶(ALP),肿瘤相关指标,包括甲胎蛋白(AFP)、癌胚抗原(CEA)、miR-181a、miR-21和miR-92a。曲线下面积(AUC)评估各指标鉴别诊断HBV相关性肝癌的价值。结果 肝癌组AST、ALT水平低于肝硬化组和CHB组(P<0.05),GGT、ALP、AFP、CEA、miR-181a、miR-21和miR-92a水平高于肝硬化组和CHB组(P<0.05);血清miR-21和miR-92a水平与肝癌患者肿瘤TNM分期有关(P<0.05)。血清AFP、CEA、miR-181a、miR-21、miR-92a及其联合检测鉴别诊断HBV相关性肝癌的AUC分别为0.820、0.760、0.699、0.788、0.751和0.934。结论 联合检测血清miR-181a、miR-21、miR-92a、AFP、CEA对HBV相关性肝癌和HBV慢性感染的鉴别诊断具有较高的应用价值。

OBJECTIVE To analyze the values of microRNA(miRNA)-181 a, miR-21 and miR-92 a in distinguishing between chronic hepatitis B virus(HBV) infection and the HBV-related liver cancer. METHODS Totally 54 patients who were diagnosed with HBV-related liver cancer in the Affiliated Hospital of Southwest Medical University from Dec 2017 to Dec 2020 were assigned as the liver cancer group, meanwhile, 54 patients who were diagnosed with chronic hepatitis B(CHB) were assigned as the CHB group, and 54 patients who were diagnosed with HBV-related liver cirrhosis were assigned as the liver cirrhosis group. The levels of liver function indexes, including aspartate aminotransferase(AST), alanine aminotransferase(ALT), glutamyl transpeptidase(GGT) and alkaline phosphatase(ALP), and the tumor-related indexes, including alpha-fetoprotein(AFP), carcinoembryonic antigen(CEA), miR-181 a, miR-21 and miR-92 a, were detected, and the values of the indexes in differential diagnosis of HBV-associated liver cancer were evaluated by area under curve(AUC). RESULTS The levels of AST and ALT of the liver cancer group were significantly lower than those of the liver cirrhosis group and the CHB group(P<0.05);the levels of GGT, ALP, AFP, CEA, miR-181 a, miR-21 and miR-92 a of the liver cancer group were significantly higher than those of the liver cirrhosis group and CHB group(P<0.05). The levels of serum miR-21 and miR-92 a were associated with the tumor TNM stage of the liver cancer patients(P<0.05).The AUCs of serum AFP, CEA, miR-181 a, miR-21, miR-92 a and the joint detection of the indexes were respectively 0.820, 0.760, 0.699, 0.788, 0.751 and 0.934 in differential diagnosis of HBV-related liver cancer. CONCLUSION The joint detection of serum miR-181 a, miR-21, miR-92 a, AFP and CEA has high value in differential diagnosis of HBV-related liver cancer and chronic HBV infection.