血清FIB-4、CHI3L1、GP73、AFP联合检测在乙型肝炎肝硬化鉴别诊断中的价值

Value of Combined Detection of Serum FIB-4,CHI3L1,GP73 and AFP in the Differential Diagnosis of Hepatitis B Cirrhosis

目的:研究血清纤维化-4(FIB-4)、壳多糖酶3样蛋白1(CHI3L1)、高尔基体蛋白73(GP73)、甲胎蛋白(AFP)联合检测在乙型肝炎肝硬化鉴别诊断中的价值。方法:选取2020年1月—2023年2月于赣州市赣县区人民医院就诊的乙型肝炎患者80例,按照是否发生肝硬化将其进行分组,其中发生肝硬化患者纳入硬化组(n=38),未发生肝硬化患者纳入对照组(n=42),比较两组肝功能生化指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、白蛋白(ALB)],比较两组血清FIB-4、CHI3L1、GP73、AFP水平,并采用ROC曲线分析上述指标的诊断价值。结果:两组ALT、AST、TBIL、ALB水平差异均无统计学意义(P>0.05),硬化组血清FIB-4、CHI3L1、GP73、AFP水平均显著高于对照组,差异均有统计学意义(P<0.05)。由ROC曲线得知,FIB-4的AUC可达0.956,敏感度可达100%,特异度可达90.48%,截断值为3.32;CHI3L1的AUC可达0.956,敏感度可达94.74%,特异度可达92.86%,截断值为158.15 ng/mL;GP73的AUC可达0.904,敏感度可达94.74%,特异度可达76.19%,截断值为125.14 ng/mL;AFP的AUC可达0.734,敏感度可达60.53%,特异度可达85.71%,截断值为30.50μg/L;联合诊断的AUC可达0.977,敏感度可达100%,特异度可达92.86%。结论:乙型肝炎肝硬化患者可采用FIB-4、CHI3L1、GP73、AFP进行联合诊断,使患者可及时确诊并进行治疗。

Objective:To study the value of combined detection of serum fibrosis 4(FIB-4),chitinase-3-like protein 1(CHI3L1),Golgi protein 73(GP73)and alpha-fetoprotein(AFP)in the differential diagnosis of hepatitis B cirrhosis.Method:A total of 80 patients with hepatitis B admitted to Ganxian People's Hospital,Ganzhou City from January 2020 to February 2023 were selected and grouped according to the presence or absence of cirrhosis.Patients with cirrhosis were included in cirrhosis group(n=38),and patients without cirrhosis were enrolled as control group(n=42).Liver function biochemical indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ALB)]were compared between the two groups.Serum FIB-4,CHI3L1,GP73 and AFP levels were compared between the two groups.ROC curve was used to analyze the diagnostic value of the above indicators.Result:There were no significant differences in ALT,AST,TBIL and ALB between the two groups(P>0.05).The levels of serum FIB-4,CHI3L1,GP73 and AFP in cirrhosis group were significantly higher than those in control group,with statistically significant differences(P<0.05).According to ROC curve,the AUC,sensitivity,specificity and cut-off value were 0.956,100%,90.48%and 3.32 of FIB-4,0.956,94.74%,92.86%and 158.15 ng/mL of CHI3L1,0.904,94.74%,76.19%and 125.14 ng/mL of GP73,and were 0.734,60.53%,85.71%and 30.50μg/L of AFP.The AUC,sensitivity and specificity of combined diagnosis were 0.977,100%and 92.86%.Conclusion:The combination of FIB-4,CHI3L1,GP73 and AFP in the diagnosis of hepatitis B cirrhosis can diagnose and treat patients in time.