PDGF、BNP、AFP-L3在乙型肝炎肝硬化患者预后评估中的价值
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摘要
目的分析血小板衍生生长因子(PDGF)、脑钠肽(BNP)、甲胎蛋白-L3(AFP-L3)在乙型肝炎肝硬化患者血清中的表达及评估患者预后质量的价值。方法选取2015年1月至2018年1月间本院收治的80例预后质量良好的慢性乙型肝炎肝硬化患者作为观察组,80例预后质量较差的慢性乙型肝炎肝硬化患者作为对照组;采用酶联免疫吸附法检测患者血中PDGF、BNP、AFP-L3水平,并绘制ROC曲线分析各指标诊断价值。结果观察组患者血中PDGF、BNP、AFP-L3水平分别为(74.83±5.93)pg/mL、(204.83±23.19)pg/mL、(59.85±6.11)ng/mL,均明显低于对照组的(113.48±7.54)pg/mL、(335.32±25.21)pg/mL、(84.83±7.98)ng/mL,且差异有统计学意义(P<0.05);以PDGF作为诊断指标良好共81例,以BNP作为诊断指标良好共83例,以AFP-L3作为诊断指标良好共75例,以平行联合作为诊断指标良好共95例,以系列联合作为诊断指标良好共64例;平行联合诊断的灵敏度(96.25%)及阴性预测值(95.38%)显著高于各指标单独诊断(P<0.05),系列联合诊断的特异度(93.75%)及阳性预测值(92.19%)均显著高于各指标单独诊断(P<0.05),平行联合及系列联合诊断的曲线下面积(AUC)(0.989、0.935)显著高于各指标单独诊断(P<0.05)。结论乙型肝炎肝硬化患者预后质量与PDGF、BNP、AFP-L3密切相关,且PDGF、BNP、AFP-L3联合诊断可作为评估患者预后质量的重要手段。
Objective To analyze the expression of platelet-derived growth factor(PDGF), brain natriuretic peptide( BNP)and alpha feto protein-L3(AFP-L3) in serum of patients with hepatitis B cirrhosis and evaluate the prognosis quality of patients. Methods From January 2015 to January 2018, 80 patients with chronic hepatitis B cirrhosis with good prognosis were selected as observation group and 80 patients with poor prognosis as control group. Diagnostic value of each index was evaluated. Results The levels of PDGF, BNP and AFP-L3 in the observation group [( 74.83±5.93)pg/mL,( 204.83±23.19)pg/mL,( 59.85 ±6.11) ng/mL] were significantly lower than those in the control group [( 113.48±7.54) pg/mL,( 335.32±25.21) pg/mL,( 84.83±7.98) ng/mL ](P<0.05). There were 81 positive cases with PDGF as the diagnostic index, 83 positive cases with BNP as the diagnostic index, 75 positive cases with AFP-L3 as the diagnostic index, 95 positive cases with parallel combination as the diagnostic index and 64 positive cases with series combination as the diagnostic index. The sensitivity( 96.25%) and negative predictive value(95.38%) of parallel combined diagnosis were significantly higher than those of individualized diagnosis(P<0.05); the specificity(93.75%) and positive predictive value(92.19%) of serial combined diagnosis were significantly higher than those of individualized diagnosis(P<0.05), and the AUC of parallel combined diagnosis(0.989) and serial combined diagnosis( 0.935) were significantly higher than those of individualized diagnosis(P<0.05). Conclusion The prognosis quality of patients with hepatitis B cirrhosis was closely related to PDGF,BNP and AFP-L3, and the combined diagnosis of PDGF, BNP and AFP-L3 could be used as an important means to evaluate the prognostis quality of patients.
Objective To analyze the expression of platelet-derived growth factor(PDGF), brain natriuretic peptide( BNP)and alpha feto protein-L3(AFP-L3) in serum of patients with hepatitis B cirrhosis and evaluate the prognosis quality of patients. Methods From January 2015 to January 2018, 80 patients with chronic hepatitis B cirrhosis with good prognosis were selected as observation group and 80 patients with poor prognosis as control group. Diagnostic value of each index was evaluated. Results The levels of PDGF, BNP and AFP-L3 in the observation group [( 74.83±5.93)pg/mL,( 204.83±23.19)pg/mL,( 59.85 ±6.11) ng/mL] were significantly lower than those in the control group [( 113.48±7.54) pg/mL,( 335.32±25.21) pg/mL,( 84.83±7.98) ng/mL ](P<0.05). There were 81 positive cases with PDGF as the diagnostic index, 83 positive cases with BNP as the diagnostic index, 75 positive cases with AFP-L3 as the diagnostic index, 95 positive cases with parallel combination as the diagnostic index and 64 positive cases with series combination as the diagnostic index. The sensitivity( 96.25%) and negative predictive value(95.38%) of parallel combined diagnosis were significantly higher than those of individualized diagnosis(P<0.05); the specificity(93.75%) and positive predictive value(92.19%) of serial combined diagnosis were significantly higher than those of individualized diagnosis(P<0.05), and the AUC of parallel combined diagnosis(0.989) and serial combined diagnosis( 0.935) were significantly higher than those of individualized diagnosis(P<0.05). Conclusion The prognosis quality of patients with hepatitis B cirrhosis was closely related to PDGF,BNP and AFP-L3, and the combined diagnosis of PDGF, BNP and AFP-L3 could be used as an important means to evaluate the prognostis quality of patients.
引文
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[12]Tsai MC,Chen CH,Hu TH,et al.Long-term outcomes of hepatitis B virus-related cirrhosis treated with nucleos(t)ide analogs[J].J Formos Med Assoc,2017,116(7):512-521.
[13]杨小瑜.肝纤维化的发病机制研究进展[J].山东医药,2017,57(11):108-110.
[14]Su TH,Kao JH.Response to Four-year entecavir therapy reduces hepatocellular carcinoma,cirrhotic events and mortality in chronic hepatitis B patients[J].Liver Int,2017,37(2):310-311.
[15]Wang PC,Wei TY,Tseng TC,et al.Cirrhosis has no impact on therapeutic responses of entecavir for chronic hepatitis B[J].Eur J Gastroenterol Hepatol,2017,29(8):946-950.
[2]葛聪聪,赵耀.隐匿性乙肝病毒感染的研究进展[J].儿科药学杂志,2017,23(12):49-52.
[3]张金良,王良超,石贵福.促炎及抗炎因子在肝癌合并HBV感染发生发展中的作用[J].热带医学杂志,2017,17(12):1622-1625.
[4]Chayanupatkul M,Omino R,Mittal S,et al.Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection[J].J Hepatol,2017,66(2):355-362.
[5]姚小健,黄红霞,陈勇.乙型肝炎肝硬化患者血清血小板衍生生长因子和叶酸水平变化[J].实用肝脏病杂志,2018,21(1):76-79.
[6]Warren-Gash C,Childs K,Thornton A,et al.Cirrhosis and liver transplantation in patients co-infected with HIV and hepatitis B or C:an observational cohort study[J].Infection,2017,45(2):215-220.
[7]Wang P,Huang G,Tam N,et al.Influence of preoperative sodium concentration on outcome of patients with hepatitis Bvirus cirrhosis after liver transplantation[J].Eur J Gastroenterol Hepatol,2016,28(10):1210-1215.
[8]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年版)[J].中华实验和临床感染病杂志:电子版,2015,19(3):1-18.
[9]郑娟,刘威龙,舒丹,等.慢乙肝抗HBV病毒治疗的现状和研究进展[J].热带医学杂志,2017,17(4):140-145.
[10]郭长峰,陈艳清,周海东,等.乙型肝炎肝硬化代偿期患者外周血小板计数和病毒血清标志物变化及与肝纤维化程度的线性关系[J].肝脏,2017,22(2):125-128.
[11]Warrengash C,Childs K,Thornton A,et al.Cirrhosis and liver transplantation in patients co-infected with HIV and hepatitis Bor C:an observational cohort study[J].Infection,2017,45(2):215-220.
[12]Tsai MC,Chen CH,Hu TH,et al.Long-term outcomes of hepatitis B virus-related cirrhosis treated with nucleos(t)ide analogs[J].J Formos Med Assoc,2017,116(7):512-521.
[13]杨小瑜.肝纤维化的发病机制研究进展[J].山东医药,2017,57(11):108-110.
[14]Su TH,Kao JH.Response to Four-year entecavir therapy reduces hepatocellular carcinoma,cirrhotic events and mortality in chronic hepatitis B patients[J].Liver Int,2017,37(2):310-311.
[15]Wang PC,Wei TY,Tseng TC,et al.Cirrhosis has no impact on therapeutic responses of entecavir for chronic hepatitis B[J].Eur J Gastroenterol Hepatol,2017,29(8):946-950.