慢性乙型肝炎患者血清α1酸性糖蛋白、α1-抗胰蛋白酶和触珠蛋白变化及其临床意义探讨

doi:10.3969/j.issn.1672-5069.2021.05.017

摘要/Abstract

摘要： 目的探讨慢性乙型肝炎(CHB)患者血清α1酸性糖蛋白(AAG)、α1-抗胰蛋白酶(AAT)和触珠蛋白(HP)及其诊断肝纤维化分期的效能。方法 2017年10月～2019年10月我院收治的CHB患者196例,采用免疫比浊法检测血清AAG、AAT和HP水平,常规行肝穿刺活检,应用受试者工作特征曲线(ROC)下面积(AUC)评价血清AAG、AAT、HP及三者联合诊断肝纤维化的效能。结果在本组196例CHB患者中,肝纤维化分期S0者18例(9.2%),S1者为38例(19.4%),>S2(显著性肝纤维化)者140例(71.4%);显著性肝纤维化患者血清AAG和HP水平分别为(0.5±0.2)g/L和(0.4±0.1)g/L,显著低于S1期【分别为(0.7±0.2)g/L和(0.8±0.3)g/L,P<0.05】或S0期【分别为(1.0±0.3)g/L和(1.3±0.4)g/L,P<0.05】,而血清AAT水平为(59.7±7.2)μmol/L,显著高于S1期【(38.4±5.5)μmol/L,P<0.05】或S0期【(29.8±3.9)μmol/L,P<0.05】;ROC曲线分析显示,血清AAG、AAT和HP诊断显著性肝纤维化的截断点分别为0.6g/L、50.2μmol/L和0.5g/L,三者联合诊断的AUC为0.844(0.769～0.902),显著高于AAG、AAT或HP单项指标诊断的AUC【分别为0.645(0.555～0.727)、0.730(0.644～0.804)和0.773(0.685～0.839),P<0.05】,与基于4因子模型(FIB-4)或天门冬氨酸氨基转移酶/血小板指数(APRI)诊断的AUC比,差异无统计学意义【分别为0.789(0.725～0.870)和0.805(0.725～0.870),P>0.05】。结论应用血清AAG、AAT和HP联合诊断CHB患者显著性肝纤维化显示出有意义的苗头,值得进一步深入探讨。

关键词: 慢性乙型肝炎, 肝纤维化, α1酸性糖蛋白, α1-抗胰蛋白酶, 触珠蛋白, 诊断

Abstract: Objective The aim of this study was to explore the probability to apply serum α1 acidic glycoprotein (AAG), α1-antitrypsin (AAT) and haptoglobin (HP) levels to diagnose the stages of liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods 196 patients with CHB were recruited in our hospital between October 2017 and October 2019, and serum AAG, AAT and HP levels were detected by immunoturbidimetric method. All patients with CHB underwent liver biopsy. The diagnostic efficacy of serum AAG, AAT, HP levels and their combination for LF staging was assessed by the area under the receiver operating characteristic (ROC) curves (AUC). Results The pathological examination of liver tissues showed that in the 196 patients with CHB, there were 18 cases (9.2%) with liver fibrosis at S0 stage, 38 cases (19.4%) at S1 stage, and 140 cases (71.4%) at >S2 (significant LF); serum AAG and HP levels in patients with significant liver fibrosis were (0.5±0.2) g/L and (0.4±0.1) g/L, significantly lower than in patients with S1 or [(1.0±0.3) g/L and (1.3±0.4) g/L, P<0.05] in patients with S0, while serum AAT level was (59.7±7.2) μmol/L, significantly higher than in patients with S1 or in patients with S0; the ROC curves analysis showed that the cut-off values of serum AAG, AAT and HP in the diagnosis of significant liver fibrosis were 0.6 g/L, 50.2 μmol/L and 0.5 g/L, respectively, with the AUC of serum AAG, AAT and HP combination was 0.844 (0.769-0.902), significantly higher than that of AAG, AAT and HP alone , which had not significant difference compared with that of fibrosis 4 score (FIB-4) or aspartate aminotransferase to platelet index (APRI) . Conclusion The combination of serum AAG, AAT and HP levels shows a promising prospect in the diagnosis of significant LF in patients with CHB, which is worthy of further investigation.

Key words: Hepatitis B, Liver fibrosis, α1-acidic glycoprotein, α1-antitrypsin, Haptoglobin, Diagnosis

王利公, 赵珊, 白凯, 张宁, 张楠. 慢性乙型肝炎患者血清α1酸性糖蛋白、α1-抗胰蛋白酶和触珠蛋白变化及其临床意义探讨[J]. 实用肝脏病杂志, 2021, 24(5): 673-676.

Wang Ligong, Zhao Shan, Bai Kai, et al. Serum α1 acidic glycoprotein, α1-antitrypsin and haptoglobin levels could be applied to predict hepatic fibrosis in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2021, 24(5): 673-676.

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