血清腱糖蛋白-C和多种肝纤维化指数诊断慢性乙型肝炎患者肝纤维化效能研究*

doi:10.3969/j.issn.1672-5069.2026.02.007

摘要/Abstract

摘要： 目的探讨血清腱糖蛋白-C(TN-C)及γ-谷氨酰转肽酶/血小板比值(GPR)、天冬氨酸氨基转移酶/血小板比率指数(APRI)、非酒精性脂肪性肝病肝纤维化评分(NFS)、纤维化4因子指数(FIB-4)和S指数诊断慢性乙型肝炎(CHB)患者肝纤维化的价值。方法 2021年1月～2024年12月我院诊治的163例CHB患者,均接受经皮肝穿刺活检,常规检测血清和血液指标,计算各指数,采用ELISA法检测血清TN-C水平。应用Logistic回归分析影响进展性肝纤维化发生的因素,应用受试者工作特征曲线(ROC)评估血清TN-C和各指数诊断CHB患者发生进展性肝纤维化的效能。结果在163例CHB患者中,经肝组织病理学检查诊断无肝纤维化50例,显著性肝纤维化52例和进展性肝纤维化48例;进展期肝纤维化组血清TN-C、GPR、APRI、NFS、FIB-4和S指数分别为(62.4±9.1)ng/mL、(0.6±0.2)、(1.0±0.3)、(-0.3±0.1)、(3.1±0.7)和(1.2±0.2),均显著高于显著性肝纤维化组[分别为(37.5±5.2)ng/mL、(0.2±0.1)、(0.7±0.2)、(-1.0±0.4)、(0.8±0.2)和(0.4±0.1),P＜0.05];多因素分析显示血清TN-C及GPR、APRI、NFS、FIB-4和S指数升高均为影响CHB患者发生进展性肝纤维化的独立危险因素(P＜0.05);血清TN-C联合GPR、APRI、NFS、FIB-4和S指数诊断CHB患者发生进展性肝纤维化的AUC为0.915,其灵敏度为98.4%,但特异度仅为61.8%。结论血清TN-C水平联合多种指数评估CHB患者进展性肝纤维化有一定的临床应用价值。

关键词: 慢性乙型肝炎, 肝纤维化, 腱糖蛋白-C, γ-谷氨酰转肽酶/血小板比值, 天冬氨酸氨基转移酶/血小板比率指数, 非酒精性脂肪性肝病肝纤维化评分, 纤维化4因子指数, S指数, 诊断

Abstract: Objective The aim of this study was to explore the diagnostic performance of serum tenascin-C (TN-C) level as well as gamma-glutamy transpeptidase-to-platelet ratio (GPR), aspartate transaminase-to-platelet ratio index (APRI),non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis index based on four factors (FIB-4) and S index for liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods A total of 163 patients with CHB were enrolled in our hospital between January 2021 and December 2024, and all underwent percutaneous liver biopsy. Serum and blood tests were routinely performed to calculate LF indexes. Serum TN-C level was detected by ELISA, the influencing factors of advanced liver fibrosis (ALF) was analyzed by multivariate Logistic regression analysis, and the diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curves. Results Of the 163 patients with CHB, the liver histo-pathological examination found no LF in 50 cases, significant LF (SLF) in 52 cases and ALF in 48 cases; serum TN-C level, GPR, APRI, NFS, FIB-4 and S index in patients with ALF were (62.4±9.1)ng/mL, (0.6±0.2), (1.0±0.3), (-0.3±0.1), (3.1±0.7) and (1.2±0.2), all significantly higher than [(37.5±5.2)ng/mL, (0.2±0.1), (0.7±0.2), (-1.0±0.4), (0.8±0.2) and (0.4±0.1), respectively, P＜0.05] in patients with SLF; Logistic regression analysis showed that increased serum TN-C level as well as GPR, APRI, NFS, FIB-4 and S index were all the independent risk factors for ALF in patients with CHB (P＜0.05); the AUC was 0.915, with sensitivity of 98.4% and specificity of 61.8% when combination of serum TN-C level and LF indexes mentioned above in predicting ALF in patients with CHB. Conclusion The combination of serum TN-C level and GPR, APRI, NFS, FIB-4 and S index in diagnosing ALF in patients with CHB is satisfactory, which needs further clinical investigation.

Key words: Hepatitis B, Liver fibrosis, Tenascin-c, Gamma-glutamy transpeptidase-to-platelet ratio, Aspartate transaminase-to-platelet ratio index, NAFLD fibrosis score, Fibrosis index based on four factors, S index, Diagnosis

黄炎芳, 李远, 李政, 黎坚. 血清腱糖蛋白-C和多种肝纤维化指数诊断慢性乙型肝炎患者肝纤维化效能研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 187-190.

Huang Yanfang, Li Yuan, Li Zheng, et al. Diagnostic performance of serum tenascin-C level and various liver fibrosis indexes for liver fibrosis in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2026, 29(2): 187-190.

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血清腱糖蛋白-C和多种肝纤维化指数诊断慢性乙型肝炎患者肝纤维化效能研究^*

Diagnostic performance of serum tenascin-C level and various liver fibrosis indexes for liver fibrosis in patients with chronic hepatitis B

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