摘要
目的 探讨乙型肝炎肝硬化患者病情分期及肝硬化失代偿并发腹腔积液诊断中血清微小RNA(miR)-25-3p和整合素结合唾液酸蛋白(IBSP)表达的应用价值.方法 回顾性选取2021年11月至2023年12月大庆龙南医院收治的乙型肝炎肝硬化患者150例、慢性乙型肝炎患者50例、健康体检人员50名分别作为肝硬化组、肝炎组、健康组.统计分析3组研究对象的血清miR-25-3p和IBSP表达水平;分析不同临床参数与血清miR-25-3p和IBSP表达水平关系;分析肝硬化患者肝功能评分与血清miR-25-3p和IBSP表达水平的相关性;采用多因素Logistic回归分析影响肝硬化失代偿并发腹腔积液的因素;采用受试者操作特征(ROC)曲线分析血清miR-25-3p和IBSP表达水平单独与联合检测在肝硬化失代偿并发腹腔积液诊断中的价值.结果 肝硬化组患者的血清miR-25-3p和IBSP表达水平分别为 5.21±0.40、(9.33±1.27)ng/mL,均明显高于肝炎组[1.15±0.33、(3.14±0.36)ng/mL]、健康组[0.91±0.11、(1.01±0.30)ng/mL],差异均有统计学意义(P＜0.05);肝炎组患者的血清miR-25-3p和IBSP表达水平均明显高于健康组,差异均有统计学意义(P＜0.05).中、重度肝纤维化、有消化道出血、有腹腔积液患者的血清miR-25-3p和IBSP表达水平均分别高于轻度肝纤维化、无消化道出血、无腹腔积液患者,差异均有统计学意义(P＜0.05);不同性别、年龄患者的血清miR-25-3p和IBSP表达水平之间比较,差异均无统计学意义(P＞0.05).肝硬化组患者的Child-Pugh评分、血清蛋白胆红素评分(ALBI)、终末期肝病模型评分(MELD)与血清miR-25-3p和IBSP表达水平均呈显著正相关(P＜0.05).肝硬化失代偿并发腹腔积液影响因素包括miR-25-3p、IBSP(P＜0.05).肝硬化失代偿并发腹腔积液诊断中血清miR-25-3p和IBSP表达水平联合检测的曲线下面积、敏感度、特异度和约登指数均明显高于单独检测(P＜0.05).结论 乙型肝炎肝硬化患者病情越重,血清miR-25-3p和IBSP表达水平越高.检测血清miR-25-3p和IBSP表达水平能够为乙型肝炎肝硬化病情的判断及肝硬化失代偿并发腹腔积液的诊断提供有效依据.
Abstract
Objective To investigate the application value of serum microRNA(miR)-25-3p and integrin bound sialic acid protein(IBSP)expression in the diagnosis of staging of hepatitis B and decompensated liver cirrhosis and ascites of cirrhosis patients.Methods A total of 150 patients with hepatitis B cirrhosis,50 patients with chronic hepatitis B,and 50 health examination personnel admitted to Daqing Longnan Hospital from November 2021 to December 2023 were retrospectively selected as the cirrhosis group,the hepatitis group,and the health group.The serum miR-25-3p and IBSP expression levels of three study subjects were statistically analyzed,as well as the relationship between different clinical parameters and serum miR-25-3p and IBSP expression levels was analyzed.The correlation between liver function score and serum miR-25-3p and IBSP expression levels in patients with liver cirrhosis was analyzed.The factors affecting decompensated liver cirrhosis and concur-rent abdominal effusion were analyzed using multiple Logistic regression analysis.The value of serum miR-25-3p and IBSP expression levels de-tected separately and in combination in the diagnosis of decompensated liver cirrhosis complicated with ascites was analyzed using receiver operating characteristic(ROC)curves.Results The expression levels of serum miR-25-3p and IBSP in patients with liver cirrhosis were 5.21±0.40 and(9.33±1.27)ng/mL,respectively,which were significantly higher than those in the hepatitis group[1.15±0.33 and(3.14±0.36)ng/mL]and the healthy group[0.91±0.11 and(1.01±0.30)ng/mL],and the differences were statistically significant(P＜0.05);the expres-sion levels of serum miR-25-3p and IBSP in the hepatitis group were significantly higher than those in the healthy group,and the differences were statistically significant(P＜0.05).The expression levels of serum miR-25-3p and IBSP in patients with moderate to severe liver fibro-sis,gastrointestinal bleeding,and abdominal fluid accumulation were higher than those in patients with mild liver fibrosis,no gastrointestinal bleeding,and no abdominal fluid accumulation,and the differences were statistically significant(P＜0.05);there were no statistically signifi-cant differences in the expression levels of serum miR-25-3p and IBSP among patients of different genders and ages(P＞0.05).The Child-Pugh score,albumin bilincbin score(ALBI),end stage liver disease model score(MELD)and serum miR-25-3p and IBSP expression levels were significantly positively correlated in cirrhosis group(P＜0.05).The influencing factors of decompensation complicated with abdominal fluid included miR-25-3p and IBSP(P＜0.05).The area under the curve,sensitivity,specificity,and Jordan's index of the combined detection of serum miR-25-3p and IBSP expression levels in the diagnosis of decompensated liver cirrhosis with concurrent abdominal effusion were signif-icantly higher than those detected alone(P＜0.05).Conclusion The more severe the condition of patients with hepatitis B cirrhosis,the high-er the expression levels of serum miR-25-3p and IBSP.Testing the expression levels of serum miR-25-3p and IBSP in the diagnosis of hepa-titis B cirrhosis and decompensated liver cirrhosis complicated with ascites can provide effective evidence for clinical practice.
基金项目
黑龙江省卫健委医学科研面上项目(H2022029)
NETL
NSTL
万方数据