摘要
目的 探究瞬时弹性成像技术联合血清正五聚体蛋白3(Pentraxin3,PTX3)、几丁质酶样蛋白40(YKL-40)对乙型肝炎肝纤维化程度的诊断价值.方法 选取2020年10月至2023年3月来郑州市第六人民医院治疗的188例确诊的乙型肝炎患者为研究对象,根据肝穿刺活检结果以及Metavir评分分为肝硬化组(n=43)、显著纤维化组(n=70)、无显著纤维化组(n=75).另选取同期来医院体检的188例健康者为对照组.采用酶联免疫吸附测定法(ELISA)检测血清PTX3、YKL-40水平;采用Spearman法分析血清PTX3、YKL-40水平与肝纤维化程度之间的相关性;受试者工作特征(ROC)曲线分析瞬时弹性成像技术联合血清PTX3、YKL-40水平对乙型肝炎肝纤维化程度的诊断价值.结果 与对照组比较,观察组HA、ColIV、LN、TBIL、LSM水平显著升高,PⅢNP水平显著降低(P＜0.05);观察组血清PTX3、YKL-40水平与对照组相比显著升高(P＜0.05);随着纤维化程度逐渐加重,血清PTX3、YKL-40水平及LSM逐渐升高,差异具有统计学意义(P＜0.05);血清PTX3、YKL-40水平及LSM与肝纤维化程度均呈正相关(r=0.616、0.441、0.468,P=0.000、0.000、0.000);瞬时弹性成像技术联合血清PTX3、YKL-40水平诊断肝硬化的曲线下面积(AUC)分别为0.782、0.657、0.746,三者联合诊断的AUC为0.846,三者联合与各指标单独诊断相比具有较高的诊断价值(Z三者联合-ptx3=1.985、Z三者联合-YKL-40=4.405、Z三者联合-LSM=2.748,P=0.047、0.000、0.006).结论 乙型肝炎患者血清PTX3、YKL-40水平均上调,且PTX3、YKL-40水平与肝纤维化程度密切相关,瞬时弹性成像技术联合血清PTX3、YKL-40对肝硬化具有较高的诊断价值.
Abstract
Objective To explore the diagnostic value of transient elastography combined with serum pentraxin-3(PTX3)and chitinase-like protein 40(YKL-40)for the degree of liver fibrosis in hepatitis B.Methods A total of 188 confirmed hepatitis B patients treated in our hospital from October 2020 to March 2023 were collected as the research subjects,according to the results of liver biopsy and Metavir score,they were separated into liver cirrhosis group(n=43),significant fibrosis group(n=70),and no significant fibrosis group(n=75).Another 188 healthy individuals who came to our hospital for physical examination were regarded as the control group.Enzyme linked immunosorbent assay(ELISA)was applied to detect serum PTX3 and YKL-40 levels;Spearman method was applied to analyze the correla-tion between serum PTX3,YKL-40 levels and the degree of liver fibrosis;receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of transient elastography combined with serum PTX3 and YKL-40 levels for the degree of liver fibrosis in hepatitis B.Results Compared with the control group,the levels of HA,C IV,LN,TBIL,and LSM in the observation group were obviously higher,while the levels of P Ⅲ and P were obviously lower(P＜0.05);the levels of serum PTX3 and YKL-40 in the observation group were obviously higher than those in the control group(P＜0.05);as the degree of fibrosis gradually worsened,the levels of serum PTX3,YKL-40,and LSM gradually increased(P＜0.05);the levels of serum PTX3,YKL-40,and LSM were positively correlated with the degree of liver fi-brosis(r=0.616,0.441,0.468,P=0.000,0.000,0.000);the area under the curve(AUC)of transient elastography combined with serum PTX3 and YKL-40 levels in the diagnosis of liver cirrhosis was 0.782,0.657,and 0.746,respec-tively,the AUC of the combined diagnosis of the three was 0.846,and the three combination had higher diagnostic value compared to the individual diagnosis of various indicators(Zthree combination-PTx3=1.985,Zthree combination-YKL-40=4.405,Zthree combination-LSM=2.748,P=0.047,0.000,0.006).Conclusion The serum levels of PTX3 and YKL-40 in hepatitis B patients are up-regulated,and the levels of PTX3 and YKL-40 are closely related to the degree of liver fibrosis.The combination of transient elastography and serum PTX3 and YKL-40 has high diagnostic value for liver cirrhosis.
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