慢性丙型肝炎患者血清N-寡糖和胆汁酸水平变化判断肝纤维化临床价值分析*

doi:10.3969/j.issn.1672-5069.2022.04.013

摘要/Abstract

摘要： 目的探讨应用血清N-寡糖、总胆汁酸(TBA)联合肝脏硬度检测(LSM)评估慢性丙型肝炎(CHC)患者肝纤维化的临床价值。方法 2018年6月～2021年6月我院收治的CHC患者84例和健康体检者51例。使用全自动生化分析仪检测血清TBA水平,应用测序仪及其数据分析软件检测血清N-寡糖相对含量,使用Fibroscan-502检测LSM值。应用受试者工作特征曲线(ROC)计算曲线下面积(AUC),评价联合检测的诊断价值。结果 CHC组血清N-寡糖和TBA水平分别为(4.1±0.8)和(20.0±3.1)μmol/L,显著高于对照组【分别为(1.6±0.3)和(8.6±1.5)μmol/L,LSM值为(16.7±2.9)kPa,显著大于对照组【(6.3±0.4)kPa,P<0.05】;肝组织学检查发现,肝纤维化S₁期19例、S₂期21例、S₃期26例和S₄期18例;S₁期、S₂期、S₃期和S₄期患者血清N-寡糖分别为(2.5±0.6)、(3.8±0.7)、(4.3±0.7)和(5.7±1.0),血清TBA水平分别为(11.3±2.5)μmol/L、(18.5±3.1)μmol/L、(21.4±3.7)μmol/L和(28.7±4.1)μmol/L,LSM值为分别为(6.3±1.7)kPa、(13.8±2.1)kPa、(17.9±3.2)kPa和(29.4±4.6)kPa,提示随肝纤维化程度的升高各指标也升高(P<0.05);联合检测评估CHC患者进展期肝纤维化的AUC为0.918(95%CI:0.862～0.973,Se为90.9%,Sp为77.5%,Ac为84.5%),显著大于血清N-寡糖【0.785(95%CI:0.675～0.894),Se为93.2%,Sp为67.5%,Ac为81.0%】、TBA【0.769(95%CI:0.668～0.870),Se为68.2%,Sp为77.5%,Ac为72.6%】或LSM值【0.802(95%CI:0.708～0.895),Se为75.0%,Sp为80.0%,Ac为77.4%】等单项检测(P<0.05)。结论应用血清N-寡糖、TBA联合LSM评估CHC患者肝纤维化程度具有一定的临床价值,值得进一步研究。

关键词: 慢性丙型肝炎, N-寡糖, 胆汁酸, 肝脏硬度检测, 肝纤维化, 诊断

Abstract: Objective The aim of this study was to explore the clinical evaluation of liver fibrosis (LF) by serum N-oligosaccharide and total bile acid (TBA) levels and liver stiffness measurement (LSM) combination in patients with chronic hepatitis C (CHC). Methods A total of 84 patients with CHC and 51 healthy individuals were enrolled in our hospital between June 2018 and June 2021. Serum TBA levels were detected by full-automatic biochemical analyzer. The relative content of serum N-oligosaccharide was detected and calculated with data analysis software. The LSM was detected by Fibroscan-502. The diagnostic value of combined parameters was evaluated by area under the receiver operating characteristic (ROC) curve (AUC). Results Serum N-oligosaccharide and TBA levels in patients with CHC were(4.1±0.8) and (20.0±3.1)μmol/L, significantly higher than [(1.6±0.3) and (8.6±1.5)μmol/L, and the LSM was (16.7±2.9)kPa, significantly higher than [(6.3±0.4)kPa, P<0.05] in the control; the liver histopathological examination showed LF S₁ in 19 cases, S₂ in 21 cases, S₃ in 26 cases and S₄ in 18 cases; serum N-oligosaccharide levels in patients with S₁, S₂, S₃ and S₄ were (2.5±0.6), (3.8±0.7), (4.3±0.7) and (5.7±1.0), serum TBA levels were (11.3±2.5)μmol/L, (18.5±3.1)μmol/L, (21.4±3.7)μmol/L and (28.7±4.1)μmol/L, and the LSM were (6.3±1.7)kPa, (13.8±2.1)kPa, (17.9±3.2)kPa and (29.4±4.6)kPa, suggesting they increased as the LF severer (P<0.05); the AUC by the three parameter combination in predicting LF was 0.918(95%CI:0.862-0.973, with Se of 90.9%, Sp of 77.5% and Ac of 84.5%), significantly higher than [0.785(95%CI:0.675-0.894), with Se of 93.2%, Sp of 67.5% and Ac of 81.0%] by serum N-oligosaccharide levels, or [0.769(95%CI:0.668-0.870), with Se of 68.2%, Sp of 77.5% and Ac of 72.6%] by serum TBA levels or [0.802(95%CI:0.708-0.895), with Se of 75.0%, Sp of 80.0% and Ac of 77.4%] by LSM alone(P<0.05). Conclusion The combination of serum N-oligosaccharides and TBA levels as well as LSM is of evaluation value for severity of liver fibrosis in patients with CHC, which needs further investigation.

Key words: Hepatitis C, N-oligosaccharide, Bile acid, Liver stiffness measurement, Liver fibrosis, Diagnosis

罗真真, 田海英, 葛建华, 纪元. 慢性丙型肝炎患者血清N-寡糖和胆汁酸水平变化判断肝纤维化临床价值分析^*[J]. 实用肝脏病杂志, 2022, 25(4): 504-507.

Luo Zhenzhen, Tian Haiying, Ge Jianhua, et al. Clinical evaluation of liver fibrosis by serum N-oligosaccharide and bile acid levels and liver stiffness measurement combination in patients with chronic hepatitis C[J]. Journal of Practical Hepatology, 2022, 25(4): 504-507.

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慢性丙型肝炎患者血清N-寡糖和胆汁酸水平变化判断肝纤维化临床价值分析^*

Clinical evaluation of liver fibrosis by serum N-oligosaccharide and bile acid levels and liver stiffness measurement combination in patients with chronic hepatitis C

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