血清腺苷脱氨酶对慢性HBV感染者显著肝纤维化的诊断价值

柯叶芳; 高国生; 朱喆; 陈必成

doi:10.3969/j.issn.1001-5256.2018.04.013

血清腺苷脱氨酶对慢性HBV感染者显著肝纤维化的诊断价值

DOI: 10.3969/j.issn.1001-5256.2018.04.013

1. 温州医科大学附属第一医院外科实验室
2. 浙江省宁波市妇女儿童医院检验科
3. 浙江省宁波市第二医院检验科
4. 浙江省宁波市第二医院输血科

详细信息

中图分类号: R512.62;R575.2
计量
- 文章访问数: 2495
- HTML全文浏览量: 72
- PDF下载量: 440
- 被引次数: 0
出版历程
- 出版日期: 2018-04-20

Value of serum adenosine deaminase in diagnosis of marked liver fibrosis in patients with chronic hepatitis B virus infection

Surgical Laboratory, The First Affiliated Hospital of Wenzhou Medical University

摘要

摘要: 目的探讨血清腺苷脱氨酶（ADA）诊断慢性HBV感染者显著肝纤维化的价值。方法选取2011年5月-2016年10月在宁波市第二医院接受肝活组织检查的493例慢性HBV感染者,根据肝纤维化程度将所有患者分为S0S4级,S0级79例,S1级254例,S2级103例,S3级35例,S4级22例。常规检测TBil、ALT、AST、ALP、GGT、Alb、ADA等生化指标和血常规指标,计算AST/PLT比值指数（APRI）。比较不同分级患者各指标的差异。正态分布的计量资料多组间比较采用方差分析,偏态分布计量资料组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ2检验。对各指标进行二分类logistic回归,采用受试者工作特征曲线（ROC曲线）分析ADA、APRI单独及多指标联合应用对显著肝纤维化（S≥2）的诊断价值。结果年龄、性别、TBil、ALT、AST、ALP、GGT、Alb、ADA和APRI在S0S4级肝纤维化患者中比较,差异均有统计学意义（F=11.41,χ2值分别为14.45、1...
- 腺苷脱氨酶 /
- 肝炎,乙型,慢性 /
- 肝硬化 /
- 诊断
Abstract: Objective To investigate the value of serum adenosine deaminase (ADA) in the diagnosis of marked liver fibrosis in patients with chronic hepatitis B virus (HBV) infection.Methods A total of 493 patients with chronic HBV infection who underwent liver biopsy in Ningbo No.2 Hospital from May 2011 to October 2016 were enrolled, and according to the degree of liver fibrosis, these patients were divided into S0 group with 79 patients, S1 group with 254 patients, S2 group with 103 patients, S3 group with 35 patients, and S4 group with 22 patients.Biochemical parameters including total bilirubin (TBil) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , gamma-glutamyl transpeptidase (GGT) , albumin (Alb) , and ADA were measured, routine blood test was performed, and aspartate aminotransferase-to-platelet ratio index (APRI) was calculated.These indices were compared between groups.An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between groups.The chi-square test was used for comparison of categorical data between groups.A dichotomous logistic regression analysis was performed for these indices, and the receiver operating characteristic (ROC) curve was used to analyze the value of ADA, APRI, or a combination of various indices in the diagnosis of marked liver fibrosis.Results There were significant differences in age, sex, TBil, ALT, AST, alkaline phosphatase, GGT, Alb, ADA, and APRI between the S0, S1, S2, S3, and S4 groups (F = 11.41, χ2= 14.45, 15.08, 28.27, 48.22, 48.65, 80.53, 17.03, 57.89, and 73.20, all P < 0.05) .Sex, age, and serum ADA were independent risk factors for marked liver fibrosis (odds ratio = 2.59, 1.05, and 1.12, all P < 0.01) .ADA, APRI, or a combination of various indices had a certain value in the diagnosis of marked liver fibrosis (all P < 0.01) , with an area under the ROC curve of 0.70, 0.73, and 0.75, respectively.Conclusion Serum ADA has a certain value in the diagnosis of marked liver fibrosis in patients with chronic HBV infection.
- adenosine deaminase /
- hepatitis B, chronic /
- liver cirrhosis /
- diagnosis

HTML全文

参考文献(20)

[1]WANG FS, FAN JG, ZHANG Z, et al.The global burden of liver disease:the major impact of China[J].Hepatology, 2014, 60 (6) :2099-2108.

[2]FERNANDEZ E, RODRIGO L, RIESTRA S, et al.Adenosine deaminase isoenzymes and neopterin in liver cirrhosis[J].J Clin Gastroenterol, 2000, 30 (2) :181-186.

[3] Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B (2010 version) [J].J Clin Hepatol, 2011, 27 (1) :Ⅰ-ⅩⅥ. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2010年版) [J].临床肝胆病杂志, 2011, 27 (1) :Ⅰ-ⅩⅥ.

[4]Chinese Society of Infectious Diseases and Parasitology&Chinese Society of Hepatology, Chinese Medical Association.Regimens for the prevention and treatment of viral hepatitis[J].Chin J Intern Med, 2001, 40 (1) :62-68. (in Chinese) 中华医学会传染病与寄生虫病学分会, 肝病学分会.病毒性肝炎防治方案[J].中华内科杂志, 2001, 40 (1) :62-68.

[5]CAI WM.Noninvasive diagnosis of significant liver fibrosis[J].J Clin Hepatol, 2011, 27 (7) :762-767. (in Chinese) 蔡卫民.显著肝纤维化的非创伤性诊断进展[J].临床肝胆病杂志, 2011, 27 (7) :762-767.

[6]YANG Q, LIU DP, LI LP, et al.Establishment and evaluation of noninvasive diagnostic models for fiver fibrosis in patients with chronic hepatitis B[J].Chin J Hepatol, 2017, 25 (1) :15-20. (in Chinese) 杨晴, 刘东屏, 李鲁平, 等.慢性乙型肝炎肝纤维化非创伤性诊断模型的建立与评价[J].中华肝脏病杂志, 2017, 25 (1) :15-20.

[7]LOK AS, Mc MAHON BJ.Chronic hepatitis B[J].Hepatology, 2007, 45 (2) :507-539.

[8]Review Panel for Liver Stiffness Measurement.Recommendations for the clinical application of transient elastography in liver fibrosis assessment[J].Chin J Hepatol, 2013, 21 (6) :420-424. (in Chinese) 肝脏硬度评估小组.瞬时弹性成像技术诊断肝纤维化专家意见[J].中华肝脏病杂志, 2013, 21 (6) :420-424.

[9]ZHENG J, LIU Y, ZHENG RQ, et al.Comparative study of realtime two-dimensional shear wave elastography and real-time tissue elastography in the assessment of liver fibrosis in chronic liver disease[J].Chin J Ultrasonogr, 2014, 23 (11) :944-947. (in Chinese) 郑剑, 刘勇, 郑荣琴, 等.实时二维剪切波弹性成像与实时组织弹性成像评估慢性肝病肝纤维化的比较研究[J].中华超声影像学杂志, 2014, 23 (11) :944-947.

[10]YANG ML, YAO DK.Application of magnetic resonance elastography as a non-invasive technique for diagnosis of liver fibrosis[J].J Clin Hepatol, 2016, 32 (3) :588-592. (in Chinese) 杨明磊, 姚定康.磁共振弹性成像在肝纤维化无创诊断中的应用[J].临床肝胆病杂志, 2016, 32 (3) :588-592.

[11]NIU M, DENG DY, LI YPF, et al.Values of MRE in diagnosis of stages of hepatic fibrosis:a Meta-analysis[J].J Jilin Univ:Med Edit, 2017, 43 (4) :787-793. (in Chinese) 牛猛, 邓大勇, 李云鹏飞, 等.磁共振弹性成像对肝纤维化分级诊断价值的Meta分析[J].吉林大学学报:医学版, 2017, 43 (4) :787-793.

[12]TESHALE E, LU M, RUPP LB, et al.APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B:the Chronic Hepatitis Cohort Study (CHe CS) [J].J Viral Hepat, 2014, 21 (12) :917-920.

[13]van der WEYDEN MB, KELLEY WN.Human adenosine deaminase.Distribution and properties[J].J Biol Chem, 1976, 251 (18) :5448-5456.

[14]KALKAN A, BULUT V, EREL O, et al.Adenosine deaminase and guanosine deaminase activities in sera of patients with viral hepatitis[J].Mem Inst Oswaldo Cruz, 1999, 94 (3) :383-386.

[15]KAYA S, CETIN ES, ARIDOGAN BC, et al.Adenosine deaminase activity in serum of patients with hepatitis-a useful tool in monitoring clinical status[J].J Microbiol Immunol Infect, 2007, 40 (4) :288-292.

[16]SONG PJ, GAO GS.Clinical significance of leucyl aminopeptidase and adenosine deaminase in liver diseases related to hepatitis B virus[J].Chin J Health Lab Technol, 2011, 21 (7) :1695-1696. (in Chinese) 宋佩君, 高国生.血清亮氨酸氨基肽酶和腺苷脱氨酶检测在HBV感染性肝病中的临床价值[J].中国卫生检验杂志, 2011, 21 (7) :1695-1696.

[17]CHEN W, WENG PJ, GAO GS, et al.Comparison of shear wave velocity with noninvasive serum score systems in diagnosis of liver fibrosis of patients with chronic hepatitis[J].Chin J Clin Infect Dis, 2013, 6 (5) :269-272. (in Chinese) 陈巍, 翁彭剑, 高国生, 等.剪切波速与四种无创血清评分系统对慢性肝炎患者肝纤维化诊断效果的比较[J].中华临床感染病杂志, 2013, 6 (5) :269-272.

[18] GAO YF, ZOU GZ, YE J, et al.Relationship between hepatitis B surface antigen, HBV DNA quantity and liver fibrosis severity[J].Chin J Hepatol, 2015, 23 (4) :254-257. (in Chinese) 郜玉峰, 邹桂舟, 叶珺, 等.HBs Ag和HBV DNA定量水平与肝纤维化程度的关系[J].中华肝脏病杂志, 2015, 23 (4) :254-257.

[19]HUANG R, WANG G, TIAN C, et al.Gamma-glutamyltranspeptidase to platelet ratio is not superior to APRI, FIB-4 and RPR for diagnosing liver fibrosis in CHB patients in China[J].Sci Rep, 2017, 7 (1) :8543.

[20]CAO Z, LI Z, WANG H, et al.Algorithm of Golgi protein 73 and liver stiffness accurately diagnoses significant fibrosis in chronic HBV infection[J].Liver Int, 2017, 37 (11) :1612-1621.

施引文献

资源附件(0)

访问统计