血清Lp-PLA2、Cys-C水平与HBV感染肝硬化患者Child-Pugh分级的关联性

Correlation of serum Lp-PLA2,Cys-C levels with Child-Pugh grading in HBV-infected patients with cirrhosis

目的检测乙型肝炎病毒(HBV)感染肝硬化患者血清脂蛋白相关磷脂酶A2(LpPLA2)、胱抑素C(CysC)水平,并分析其与ChildPugh分级、肝硬化程度的相关性。方法选取2020年8月至2022年10月平顶山市第一人民医院收治的153例HBV感染者为研究对象,其中肝硬化者86例(设为肝硬化组),乙型肝炎者67例(设为肝炎组),另选取同期于本院体检的健康志愿者51例作为对照组。比较各组受检者的血清LpPLA2、CysC、肝功能指标[碱性磷酸酶(ALP)、γ谷氨酰转肽酶(GGT)、白蛋白(ALB)、球蛋白(GLO)]水平,同时比较不同HBVDNA载量患者的血清LpPLA2、CysC水平。采用Pearson法分析血清LpPLA2、CysC水平与肝功能指标相关性,并采用Spearman法分析其与ChildPugh分级、肝硬化程度的相关性。采用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价血清LpPLA2、CysC对肝硬化所致原发性肝癌的诊断价值。结果肝硬化组、肝炎组、对照组受检者的血清LpPLA2水平分别为(296.34±48.78)ng/mL、(204.19±38.06)ng/mL、(101.28±23.76)ng/mL,CysC水平分别为(1.49±0.29)mg/L、(0.92±0.20)mg/L、(0.67±0.13)mg/L,ALP水平分别为(175.24±38.41)U/L、(122.92±30.97)U/L、(71.08±20.69)U/L,GGT水平分别为(188.93±52.97)U/L、(96.37±22.12)U/L、(20.31±5.77)U/L,GLO水平分别为(40.78±9.59)g/L、(33.09±8.03)g/L、(18.85±4.28)g/L,ALB水平分别为(26.30±5.77)g/L、(39.75±9.25)g/L、(48.74±10.24)g/L,肝硬化组患者的血清LpPLA2、CysC、ALP、GGT、GLO水平明显高于肝炎组和对照组,且肝炎组明显高于对照组,而血清ALB水平明显低于肝炎组和对照组,差异均有统计学意义(P<0.05);随着HBVDNA载量增加,血清LpPLA2、CysC水平呈上升趋势,且差异均有统计学意义(P<0.05);经Pearson法、Spearman法分析结果显示,血清LpPLA2、CysC水平与ALP、GGT、GLO、ChildPugh分级、肝硬化程度均呈正相关(P<0.05),而与ALB呈负相关(P<0.05);经ROC分析结果显示,血清LpPLA2、CysC联合鉴别诊断肝硬化程度的AUC大于单独指标鉴别诊断(P<0.05)。结论HBV感染肝硬化患者血清LpPLA2、CysC水平升高,且与ChildPugh分级、肝硬化程度密切相关,联合检测其水平对肝硬化所致原发性肝癌具有一定诊断价值。

Objective To detect the serum levels of lipoprotein associated phospholipase A2(LpPLA2)and cystatin C(CysC)in hepatitis B virus(HBV)infected patients with liver cirrhosis,and to analyze their correlation with ChildPugh grade and degree of liver cirrhosis.Methods A total of 153 HBVinfected patients admitted to Pingdingshan First People's Hospital from August 2020 to October 2022 were selected as the study objects,including 86 cases with cirrhosis(cirrhosis group)and 67 cases with hepatitis B(hepatitis group),and 51 healthy volunteers who underwent physical examination in the hospital during the same period were selected as the control group.The serum levels of LpPLA2,CysC,and liver function indicators[alkaline phosphatase(ALP),gammaglutamyl transpeptidase(GGT),albumin(ALB),globulin(GLO)]were compared,and the serum levels of LpPLA2,CysC were compared among patients with different HBV DNA loads.Pearson method was used to analyze the correlation between serum LpPLA2,CysC levels and liver function indicators,and Spearman method was used to analyze their correlation with ChildPugh grading and degree of cirrhosis.The diagnostic value of serum LpPLA2 and CysC in primary liver cancer caused by cirrhosis was evaluated using receiver operating characteristic curve(ROC)and area under curve(AUC).Results The serum LpPLA2 levels in the cirrhosis group,hepatitis group,and control group were(296.34±48.78)ng/mL,(204.19±38.06)ng/mL,(101.28±23.76)ng/mL;CysC levels were(1.49±0.29)mg/L,(0.92±0.20)mg/L,(0.67±0.13)mg/L;ALP-levels were(175.24±38.41)U/L,(122.92±30.97)U/L,(71.08±20.69)U/L;GGT levels were(188.93±52.97)U/L,(96.37±22.12)U/L,and(20.31±5.77)U/L,respectively;the levels of GLO were(40.78±9.59)g/L,(33.09±8.03)g/L,(18.85±4.28)g/L;the levels of ALB were(26.30±5.77)g/L,(39.75±9.25)g/L,and(48.74±10.24)g/L,respectively.The serum levels of LpPLA2,CysC,ALP,GGT,and GLO were significantly higher in the cirrhosis group than those in the hepatitis group and control group,and also in hepatitis group than the control group;the serum ALB levels were significantly lower than those in the hepatitis group and control group;the differences were statistically significant(P<0.05).The serum LpPLA2 and CysC levels increased with the increase of HBVDNA load,and the differences were statistically significant(P<0.05).Pearson and Spearman methods showed that serum levels of LpPLA2 and CysC were positively correlated with ALP,GGT,GLO,Child Pugh grading,and degree of cirrhosis(P<0.05),but negatively correlated with ALB(P<0.05).The AUC of serum LpPLA2 combined with CysC in the differential diagnosis of cirrhosis was higher than that of LpPLA2 or CysC alone(P<0.05).Conclusion The serum LpPLA2 and CysC levels in patients with HBV infection and cirrhosis are increased,which are closely related to ChildPugh grade and degree of cirrhosis.The combined detection of LPPLA2 and CYSC levels has certain diagnostic value for primary liver cancer caused by cirrhosis.