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高尔基体蛋白73和透明质酸对HBV相关慢性肝病进展的诊断价值
Clinical value of Golgi protein 73 and hyaluronic acid in diagnosis of the progression of hepatitis B virus-related chronic liver diseases
文章发布日期:2017年12月09日  来源:  作者:张丽君,刘明军,王帅,等  点击次数:103次  下载次数:19次

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【摘要】:目的 探讨高尔基体蛋白73(GP73)与透明质酸(HA)在HBV相关慢性肝病进展中的临床应用价值。方法 收集2016年12月-2017年4月就诊于青岛大学附属医院的患者142例,其中伴有肝硬化的肝细胞癌(HCC)36例(HCC组),乙型肝炎肝硬化66例(肝硬化组),慢性乙型肝炎(CHB)40例(CHB组)。另选取同一时期健康体检者30例作为对照。ELISA法检测血清中GP73浓度,化学发光法检测HA浓度。正态分布的计量资料多组间比较单因素方差分析;非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验。曲线分析比较GP73和HA单独或联合应用的临床诊断价值。受试者工作特征曲线下面积(AUC)比较采用Z检验,性别比、敏感度及特异度比较采用χ2检验。结果 CHB组、肝硬化组及HCC组患者血清GP73和HA水平均高于对照组(P值均<0.05)。肝硬化组、HCC组患者GP73和HA水平均明显高于CHB组(U值分别为677、637、291、193,P值均<0.05)。肝硬化组内比较,失代偿期患者GP73与HA水平均显著高于代偿期患者(U值分别为171、212,P值均<0.05)。对于CHB患者,GP73与HA联合检测的AUC及敏感度均高于GP73单独检测(0.950 vs 0.790,Z=2.32,P<0.05;91.70% vs 72.20%,χ2=5.14,P<0.05)。预测肝硬化时GP73的诊断敏感度高于HA(87.90% vs 69.70%,χ2=6.05,P<0.05);二者联合应用较HA单独应用特异度降低(62.30% vs 86.80%,χ2=14.60,P<0.05),敏感度提高(93.90% vs 69.70%,χ2=1180,P<0.05)。诊断失代偿期肝硬化时GP73、HA联合应用敏感度高于HA单独应用(83.80% vs 67.60%,χ2=4.17,P<0.05)。GP73、HA和AFP诊断HCC的AUC分别为0.549、0.525、0.807,GP73与HA对HCC的诊断价值不如AFP(Z值分别为3.49、3.80,P值均<0.05)。结论 GP73和HA均可作为监测HBV相关慢性肝病进展的辅助指标,联合应用对诊断肝硬化及肝硬化代偿情况具有重要的临床应用价值。
【Abstract】:Objective To investigate the clinical value of Golgi protein 73 (GP73) and hyaluronic acid (HA) in the diagnosis of the progression of hepatitis B virus (HBV)-related chronic liver diseases. Methods A total of 142 patients who visited The Affiliated Hospital of Qingdao University from December 2016 to April 2017 were enrolled, and among these patients, 36 had hepatocellular carcinoma (HCC) with liver cirrhosis, 66 had hepatitis B cirrhosis, and 40 had chronic hepatitis B (CHB). A total of 30 healthy subjects who underwent physical examination during the same period of time were enrolled as control group. ELISA was used to measure the serum level of GP73, and chemiluminescence was used to measure the level of HA. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between any two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of GP73 and HA measured alone or in combination. The Z test was used for comparison of area under the ROC curve (AUC), and the chi-square test was used for comparison of sex ratio, sensitivity, and specificity. Results The CHB group, liver cirrhosis group, and HCC group had significantly higher serum levels of GP73 and HA than the control group (all P<0.05). The liver cirrhosis group and the HCC group had significantly higher serum levels of GP73 and HA than the CHB group (U=677, 637, 291, and 193, all P<0.05). In the liver cirrhosis group, the patients with decompensated liver cirrhosis had significantly higher serum levels of GP73 and HA than those with compensated liver cirrhosis (U=171 and 212, both P<0.05). As for CHB patients, combined measurement of GP73 and HA had significantly higher AUC and sensitivity than GP73 measured alone (AUC: 0.950 vs 0.790, Z=2.32, P<0.05; sensitivity: 91.70% vs 72.20%, χ2=5.14, P<0.05). In the diagnosis of liver cirrhosis, GP73 had a significantly higher sensitivity than HA (87.90% vs 69.70%, χ2=6.05, P<0.05), and compared with HA measured alone, combined measurement of GP73 and HA had a significant reduction in specificity (62.30% vs 86.80%, χ2=14.60, P<0.05) and a significant increase in sensitivity (93.90% vs 69.70%, χ2=11.80, P<0.05). In the diagnosis of decompensated liver cirrhosis, combined measurement of GP73 and HA a significantly higher sensitivity than HA measured alone (83.80% vs 67.60%, χ2=4.17, P<0.05). GP73, HA, and alpha-fetoprotein (AFP) had an AUC of 0.549, 0.525, and 0.807, respectively, in the diagnosis of HCC, and GP73 and HA had a lower diagnostic value than AFP (Z=3.49 and 3.80, both P<0.05). Conclusion GP73 and HA can help with the monitoring of the progression of HBV-related chronic liver diseases. Combined measurement of GP73 and HA has an important clinical value in the diagnosis of liver cirrhosis and decompensated liver cirrhosis.
【关键字】:高尔基体蛋白73;透明质酸;肝炎,乙型,慢性;肝硬化;癌,肝细胞;诊断
【Key words】:Golgi protein 73; hyaluronic acid; hepatitis B, chronic; liver cirrhosis; carcinoma, hepatocellular; diagnosis
【引证本文】:ZHANG LJ, LIU MJ, WANG S, et al. Clinical value of Golgi protein 73 and hyaluronic acid in diagnosis of the progression of hepatitis B virus-related chronic liver diseases[J]. J Clin Hepatol, 2018, 34(1): 63-67. (in Chinese)
张丽君, 刘明军, 王帅, 等. 高尔基体蛋白73和透明质酸对HBV相关慢性肝病进展的诊断价值[J]. 临床肝胆病杂志, 2018, 34(1): 63-67.

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