肝硬化相关血清学指标与Child-Pugh分级的关系
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摘要
目的:探究肝硬化相关血清学指标与肝硬化Child-Pugh分级之间的关系和临床意义。方法:收集重庆医科大学附属第二医院感染科2016年7月至2017年4月间肝硬化患者血清235例,其中Child-Pugh A组55例,B组90例,C组90例,以及同期健康体检人群35例,分别检测肝功能、肝纤维化、血小板计数等指标并分析其特征。结果:透明质酸(hyaluronic acid,HA)、层粘连蛋白(laminin,LN)、Ⅲ型胶原蛋白(typeⅢcollagen,PC-Ⅲ)、Ⅳ型胶原蛋白(typeⅣcollagen,Ⅳ-C)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酰氨基转移酶(alanyl aminotransferase,ALT)及天门冬氨酸氨基转移酶与血小板计数比(aspartate aminotransferase to platelet ratio index,APRI)指数之间差异均具有统计学意义(P<0.05)。HA、PC-Ⅲ、Ⅳ-C、LN和AST指标对预测肝硬化的曲线下面积(AUC)分别为0.910、0.804、0.833、0.753、0.730。HA、PC-Ⅲ、Ⅳ-C与Child-Pugh分级呈高度正相关(r>0.7,P<0.01),APRI与分级呈显著性正相关(0.4 Objective:To investigate the correlation between serological markers for liver cirrhosis and Child-Pugh class and its clinical significance. Methods:A total of 235 patients with liver cirrhosis who were treated in Department of Infectious Diseases in The Second Affiliated Hospital of Chongqing Medical University from July 2016 to April 2017 were enrolled,among whom 55 had ChildPugh class A cirrhosis,90 had Child-Pugh class B cirrhosis,and 90 had Child-Pugh class C cirrhosis,and 35 individuals who underwent physical examination during the same period of time were enrolled as controls. The indices including liver function parameters,liver fibrosis indices,and platelet count were measured and analyzed. Results:There were significant differences between the two groups in hyaluronic acid(HA),laminin(LN),type Ⅲ collagen(PC-Ⅲ),type Ⅳ collagen(Ⅳ-C),aspartate aminotransferase(AST),alanine aminotransferase(ALT),and aspartate aminotransferase-to-platelet ratio index(APRI)(P<0.05). HA,PC-Ⅲ,Ⅳ-C,LN,and AST had an area under the ROC curve of 0.910,0.804,0.833,0.753,and 0.730,respectively. HA,PC-Ⅲ,and Ⅳ-C were positively correlated with Child-Pugh class(r>0.7,P<0.01),and APRI was positively correlated with Child-Pugh score(0.4
引文
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[3]吴钦梅,尤红.中国乙型病毒性肝炎肝硬化研究现状[J].中国病毒病杂志,2014,4(1):7-10.
[4]Tsochatzis EA,Bosch J,Burroughs AK.Liver cirrhosis[J].Lancet,2014,383(9930):1749-1761.
[5]Cassinotto C,Boursier J,De Lédinghen V,et al.Liver stiffness in nonalcoholic fatty liver disease:a comparison of supersonic shear imaging,Fibro Scan and ARFI with liver biopsy[J].Hepatology,2016,63(6):1817-1827.
[6]张红,韩静,张晓岚.《2015年日本胃肠病学会肝硬化循证医学临床实践指南》摘译[J].临床肝胆病杂志,2016,32(9):1659-1663.
[7]Lou X,Hou Y,Cao H,et al.Clinical significance of decoy receptor3 upregulation in patients with hepatitis B and liver fibrosis[J].Oncol Lett,2018,16(1):1147-1154.
[8]Qi X,Liu X,Zhang Y,et al.Serum liver fibrosis markers in the prognosis of liver cirrhosis:a prospective observational study[J].Med Sci Monit,2016,22:2720-2730.
[9]Kurokawa T,Zheng YW,Ohkohchi N.Novel functions of platelets in the liver[J].J Gastroenterol Hepatol,2016,31(4):745-751.
[10]El Serafy MA,Kassem AM,Omar H,et al.APRI test and hyaluronic acid as non-invasive diagnostic tools for post HCV liver fibrosis:systematic review and meta-analysis[J].Arab Journal of Gastroenterology,2017,18(2):51-57.
[11]Wang RQ,Zhang QS,Zhao SX,et al.Gamma-glutamyl transpeptidase to platelet ratio index is a good noninvasive biomarker for predicting liver fibrosis in Chinese chronic hepatitis B patients[J].J Int Med Res,2016,44(6):1302-1313.
[12]Li MR,Zheng HW,Lu JH,et al.Serum hepatitis B core antibody titer use in screening for significant fibrosis in treatment-na觙ve patients with chronic hepatitis B[J].Oncotarget,2017,8(7):11063-11070.
[13]Kunutsor SK.Gamma-glutamyltransferase-friend or foe within?[J].Liver Int,2016,36(12):1723-1734.