慢性乙型肝炎患者血清miR-21和miR-148b水平变化及其预测肝组织炎症分级和纤维化分期价值探讨*

doi:10.3969/j.issn.1672-5069.2022.03.008

摘要/Abstract

摘要： 目的探讨应用血清miR-21和miR-148b水平预测慢性乙型肝炎(CHB)患者肝组织病理学病变的价值。方法 2016年7月～2021年6月我院诊治的CHB患者134例,行快速肝穿刺活检,评估肝组织炎症活动度分级(G)和肝纤维化分期(S)。采用实时定量逆转录PCR法检测血清miR-21和miR-148b水平。应用受试者工作特征曲线(ROC)下面积(AUC)评估血清miR-21和miR-148b水平评估CHB患者肝组织炎症分级和纤维化分期的效能。结果经肝组织检查,在134例CHB患者中,发现肝组织炎症活动度分级包括G1级23例、G2级39例、G3级47例和G4级25例,肝纤维化分期包括S1期31例、S2期46例、S3期28例和S4期29例;G1级、G2级、G3级和G4级血清miR-21水平分别为(1.1±0.2)、(1.5±0.3)、(1.8±0.4)和(2.2±0.6),血清miR-148b水平分别为(2.4±0.5)、(2.0±0.3)、(1.6±0.5)和(1.2±0.4),组间差异有统计学意义(P＜0.05);S1期、S2期、S3期和S4期血清miR-21水平分别为(0.9±0.4)、(1.4±0.3)、(1.9±0.5)和(2.7±0.5),血清miR-148b水平分别为(2.8±0.7)、(1.9±0.4)、(1.4±0.4)和(0.9±0.2),组间差异有统计学意义(P＜0.05);分别以血清miR-21=1.5和miR-148b=2.0为截断点,其联合评估肝组织炎症分级大于或等于G2的AUC为0.875,显著高于两项指标单独评估(分别为0.769和0.781,P＜0.05),其灵敏度、特异度和准确度分别为87.0%、82.9%和83.6%;分别以血清miR-21=1.4和miR-148b=1.9为截断点,其联合评估肝纤维化分期大于或等于S2的AUC为0.898,显著高于两项指标单独评估(分别为0.782和0.770,P＜0.05),其灵敏度、特异度和准确度分别为87.1%、73.8%和76.9%。结论利用CHB患者血清miR-21高水平和miR-148b低水平的特点可以用于评估肝组织炎症分级和肝纤维化分期,值得深入研究。

关键词: 慢性乙型肝炎, 肝组织病理学, miR-21, miR-148b, 预测

Abstract: Objective The aim of this study was to explore the predictive value of serum microRNAs (miR)-21 and miR-148b for liver histopathological inflammation grading and fibrosis staging in patients with chronic hepatitis B (CHB). Methods 134 patients with CHB were enrolled in our hospital between July 2016 and June 2021, and all underwent liver biopsy. The liver tissue inflammation grading (G) and fibrosis staging (S) was evaluated. Serum miR-21 and miR-148b levels were detected by real-time quantitative PCR. The diagnostic efficacy of serum miR-21 and miR-148b levels in predicting liver damages was carried out by the area under the receiver operating characteristic curve (AUROC). Results The liver histopathological examination showed G1 in 23 cases, G2 in 39 cases, G3 in 47 cases and G4 in 25 cases, and S1 in 31 cases, S2 in 46 cases, S3 in 28 cases and S4 in 29 cases out of our 134 patients with CHB; serum miR-21 levels in patients with G1, G2, G3 and G4 were (1.1±0.2), (1.5±0.3), (1.8±0.4) and (2.2±0.6), and serum miR-148b levels were (2.4±0.5), (2.0±0.3, (1.6±0.5) and (1.2±0.4), significantly different among them (P＜0.05); serum miR-21 levels in patients with S1, S2, S3 and S4 were (0.9±0.4), (1.4±0.3), (1.9±0.5) and (2.7±0.5), and serum miR-148b levels were (2.8±0.7), (1.9±0.4), (1.4±0.4) and (0.9±0.2), significantly different among them (P＜0.05); the AUC was 0.875 in predicting significant liver inflammatory activities by the combination of serum miR-21 and miR-148b when serum miR-21=1.5 and miR-148b=2.0 were set as the cut-off-value, significantly higher than by any of the two alone (0.769 and 0.781, respectively, P＜0.05), with the sensitivity (Se), specificity (Sp) and accuracy (Ac) of 87.0%, 82.9% and 83.6%; and the AUC was 0.898 by the combination of the two parameters in predicting significant liver fibrosis when serum miR-21 =1.4 and miR-148b=1.9 were set as the cut-off-value, significantly higher than by any one of the two alone (0.782 and 0.770, respectively, P＜0.05), with the Se of 87.1%, Sp of 73.8% and Ac of 76.9%. Conclusion The diagnostic efficacy by serum miR-21 and miR-148b levels in predicting liver histopathogical injuries in patients with CHB might be high, and needs further investigation.

Key words: Hepatitis B, MicroR-21, MiR-148b, Liver inflammation grading, Fibrosis staging, Prediction

罗珂, 丁莉, 刘美. 慢性乙型肝炎患者血清miR-21和miR-148b水平变化及其预测肝组织炎症分级和纤维化分期价值探讨^*[J]. 实用肝脏病杂志, 2022, 25(3): 335-338.

Luo Ke, Ding Li, Liu Mei. Serum miR-21 and miR-148b levels in patients with chronic hepatitis B and their predictive value for liver tissue inflammation grading and fibrosis staging[J]. Journal of Practical Hepatology, 2022, 25(3): 335-338.

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慢性乙型肝炎患者血清miR-21和miR-148b水平变化及其预测肝组织炎症分级和纤维化分期价值探讨^*

Serum miR-21 and miR-148b levels in patients with chronic hepatitis B and their predictive value for liver tissue inflammation grading and fibrosis staging

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