总肝体积/脾脏体积联合血清外泌体miR-214在乙型肝炎肝硬化患者中的评估应用

Application of whole liver volume/spleen volume combined with serum exosomal miR-214 in evaluating hepati⁃tis B cirrhosis

目的探讨总肝体积/脾脏体积联合血清外泌体miR-214在乙型肝炎肝硬化患者中的评估应用。方法选取因慢性乙型肝炎导致的肝纤维化49例和肝硬化患者21例作为研究对象,以同期健康体检者50例为对照组。三组患者均进行CT扫描,测量三组患者总肝体积、肝右叶体积、左内叶体积、左外叶体积和脾脏体积、血清外泌体miR-214水平和HBV-DNA载量,并计算总肝体积/脾脏体积的比值,分析总肝体积/脾脏体积、miR-214两指标联合诊断肝硬化的诊断价值。结果纤维化组、对照组、肝硬化组肝右叶、左内叶、总肝体积依次降低,肝硬化组、纤维化组、对照组左外叶体积依次降低(F分别=34.54、55.19、70.85、20.43,P均<0.05)。对照组、纤维化组、肝硬化组脾脏体积、上下径、厚度水平依次升高(F分别=342.82、80.38、94.45,P均<0.05)。对照组、纤维化组、肝硬化组肝右叶、左内叶、左外叶、总肝体积与脾脏体积比依次降低(F分别=106.75、106.09、59.66、168.88,P均<0.05)。对照组、纤维化组、肝硬化组HBV-DNA载量与miR-214水平依次升高(F分别=560.30、350.00,P均<0.05)。ROC曲线显示,总肝体积/脾脏体积、miR-214两指标联合诊断肝硬化曲线下面积为0.92,明显高于各单项指标曲线下面积(Z分别=3.02、3.05,P均<0.05)。结论肝纤维化患者和肝硬化患者各肝叶体积与脾脏体积比均减小,血清外泌体miR-214水平和HBV-DNA载量均升高,且总肝体积/脾脏体积、miR-214两指标联合诊断肝硬化有一定价值。

Objective To investigate the application of whole liver volume/spleen volume combined with serum exosomal miR-214 in evaluating hepatitis B cirrhosis.Methods Totally 49 patients suffer from liver fibrosis and 21 patients cirrhosis caused by chronic hepatitis B were selected as the research objects,and 50 healthy subjects during the same period were selected as the control group.Upper abdomen of three groups patients was scanned by CT.Total liver volume,right liver lobe volume,left inner lobe volume,left outer lobe volume,serum exosomal miR-214 level and HBVDNA load were calculated,and the ratio of whole liver volume/spleen volume was calculated.The combined diagnosis value of whole liver volume/spleen volume and miR-214 for liver cirrhosis was analyzed.Results The right lobe,left inner lobe,and total liver volume in the fibrosis group,control group,and liver cirrhosis group decreased gradually,and the left lateral lobe volume in the liver cirrhosis group,fibrosis group,and control group decreased gradually(F=34.54,55.19,70.85,20.43,P<0.05).The spleen volume,upper and lower diameter,and thickness of the control group,fibrosis group,and liver cirrhosis group increased gradually(F=342.82,80.38,94.45,P<0.05).The right lobe,left inner lobe,left outer lobe,and the ratio of wholeliver volume to spleen volume in the control group,fibrosis group,and liver cirrhosis group decreased gradually(F=106.75,106.09,59.66,168.88,P<0.05).The HBV-DNA load and the level of miR-214 in the control group,fibrosis group and liver cirrhosis group were increased gradually(F=560.30,350.00,P<0.05).The area under the ROC of whole liver volume/spleen volume combined with miR-214 for diagnosing liver cirrhosis was 0.92,which was significantly higher than the area under the ROC of each single index(Z=3.02,3.05,P<0.05).Conclu⁃sion The ratio of liver lobe volume to spleen volume in patients with liver fibrosis and liver cirrhosis was decreased,serum exosomal miR-214 level and HBV-DNA load were increased,The combination of the whole liver volume/spleen volume and miR-214 has a certain value in the diagnosis of liver cirrhosis.