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血清AFP对慢性乙型肝炎肝纤维化程度的预测价值
Value of serum alpha-fetoprotein in predicting liver fibrosis in patients with chronic hepatitis B
文章发布日期:2018年04月04日  来源:  作者:程婉秋,管世鹤,张浩,等  点击次数:603次  下载次数:73次

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【摘要】:目的探讨血清AFP与乙型肝炎肝纤维化等级的关系,评估血清AFP对乙型肝炎肝纤维化的预测价值。方法收集2015年5月-2017年5月安徽医科大学第二附属医院已确诊的慢性乙型肝炎(CHB)住院患者286例,另选取2016年3月-2017年6月本院门诊体检中心体检合格健康成人150例作为健康对照组。CHB患者行肝穿刺活组织检查,血液学指标检测PLT、ALT、AST、TBil、Alb、Glo、ALP、GGT、AFP、HBV DNA、HBsAg等。符合正态分布的计量资料2组间比较采用独立样本t检验,非正态分布的计量资料组间比较采用Mann-Whitney U检验;AFP与临床指标的相关性分析采用Spearman秩和分析;血清AFP水平预测肝纤维化的敏感性和特异性分析采用受试者工作特征曲线(ROC曲线)评估。结果286例CHB患者中肝纤维化分级S0 19例、S1 156例、S2 52例、S3 39例、S4 20例,经Spearman相关性分析发现血清AFP水平与肝纤维化分级呈正相关(r=0.373,P<0.000 1);CHB患者血清AFP水平为2.89(1.87~5.59)ng/ml,健康对照组AFP水平为2.11(1.21~3.10)ng/ml,差异有统计学意义(P=0002 7)。CHB非显著纤维化患者血清AFP水平为2.51(1.70~3.81)ng/ml,显著纤维化患者AFP水平为4.17(2.42~14.06)ng/ml,差异有统计学意义(P=0.006 9);CHB患者血清AFP水平与ALT、AST等肝功能指标呈正相关(r值分别为0.393、0.419,P值均<0000 1),且与HBV DNA呈正相关(r=0.231,P<0.05)。此外,AFP水平与HBsAg无明显相关性(r=0.154,P>0.05);相关性分析发现CHB患者血清AFP水平与APRI评分呈正相关(r=0.342,P<0.000 1);ROC曲线评估CHB患者血清AFP水平预测肝纤维化临床价值,截断值为3.8 ng/ml时,特异性和敏感性分别为84.92%和37.41%,95%可信区间2.03~8.00 ng/ml,其ROC曲线下面积为0.674(P<0000 1)。结论CHB患者血清AFP水平随着肝纤维化等级升高而逐渐增高,具有评估肝脏显著性纤维化的临床应用价值。
【Abstract】:ObjectiveTo investigate the correlation between serum alpha-fetoprotein (AFP) and classification of liver fibrosis in patients with chronic hepatitis B (CHB), as well as the value of serum AFP in predicting liver fibrosis in CHB patients. MethodsA total of 286 patients with a confirmed diagnosis of CHB who were hospitalized in our hospital from May 2015 to May 2017 were enrolled, and 150 healthy adults who underwent physical examination at the Physical Examination Center in our hospital from March 2016 to June 2017 and had qualified results were enrolled as healthy control group. Liver biopsy was performed for CHB patients, and related hematological parameters were measured, including platelet count (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), albumin (Alb), globulin (GLB), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (γ-GGT), AFP, HBV DNA, and hepatitis B surface antigen (HBsAg). The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; a Spearman correlation analysis was used to investigate the correlation between AFP and clinical indices; the receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of serum AFP level in predicting liver fibrosis. ResultsOf all 286 CHB patients, 19 had S0 liver fibrosis, 156 had S1 liver fibrosis, 52 had S2 liver fibrosis, 39 had S3 liver fibrosis, and 20 had S4 liver fibrosis; the Spearman correlation analysis showed that serum AFP level was positively correlated with the classification of liver fibrosis (r=0.373, P<0.000 1). There was a significant difference in serum AFP level between the CHB group and the healthy control group [2.89 (1.87-5.59) ng/ml vs 2.11 (121-3.10) ng/ml, P=00027]. There was also a significant difference in serum AFP level between the CHB patients with insignificant liver fibrosis and those with significant liver fibrosis [2.51 (1.70-3.81) ng/ml vs 4.17 (2.42-14.06) ng/ml, P=00069]. In CHB patients, serum AFP level was positively correlated with ALT (r=0.393, P<0.000 1), AST (r=0.419, P<0.000 1), and HBV DNA (r=0.231, P<0.05). There was no significant correlation between AFP level and HBsAg (r=0.154, P>0.05). The correlation analysis showed that serum AFP level was positively correlated with aspartate aminotransferase-to-platelet ratio index in CHB patients (r=0342, P<0000 1). The ROC curve was used to investigate the value of serum AFP level in predicting liver fibrosis, and the results showed that at the cut-off value of 3.8 ng/ml, serum AFP level had a specificity of 84.92%, a sensitivity of 37.41%, and an area under the ROC curve of 0.674 (P<0.0001 ), with a 95% confidence interval of 2.03-8.00 ng/ml. ConclusionIn CHB patients, serum AFP level increases with the increase in liver fibrosis grade, and therefore, it has a good clinical value in evaluating significant liver fibrosis.
【关键字】:肝炎, 乙型, 慢性; 肝硬化; 甲胎蛋白类
【Key words】:hepatitis B, chronic; liver cirrhosis; alpha-fetoproteins
【引证本文】:CHENG WQ, GUAN SH, ZHANG H, et al. Value of serum alpha-fetoprotein in predicting liver fibrosis in patients with chronic hepatitis B[J]. J Clin Hepatol, 2018, 34(5): 1015-1019. (in Chinese) 程婉秋, 管世鹤, 张浩, 等. 血清AFP对慢性乙型肝炎肝纤维化程度的预测价值[J]. 临床肝胆病杂志, 2018, 34(5): 1015-1019.

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