透明质酸和层粘连蛋白作为血清标志物预测慢性乙型肝炎患者显著纤维化的作用。

Role of hyaluronic acid and laminin as serum markers for predicting significant fibrosis in patients with chronic hepatitis B.

机构信息

Department of Gastroenterology, Digestive Disease Research Center, Affiliated Hospital, Nantong University, China.

出版信息

Braz J Infect Dis. 2012 Jan-Feb;16(1):9-14. doi: 10.1016/s1413-8670(12)70267-2.

DOI:10.1016/s1413-8670(12)70267-2

PMID:22358349

Abstract

OBJECTIVES

The aim of this study was to evaluate the diagnostic performance of serum HA and LN as serum markers for predicting significant fibrosis in CHB patients.

METHODS

Serum HA and LN levels of 87 patients with chronic hepatitis B and 19 blood donors were assayed by RIA. Liver fibrosis stages were determined according to the Metavir scoring-system. The diagnostic performances of all indexes were evaluated by the receiver operating characteristic (ROC) curves.

RESULTS

Serum HA and LN concentrations increased significantly with the stage of hepatic fibrosis, which showed positive correlation with the stages of liver fibrosis (HA: r = 0.875, p < 0.001; LN: r = 0.610, p < 0.001). There were significant differences of serum HA and LN levels between F2-4 group in comparison with those in F0-F1 group (p < 0.001) and controls (p < 0.001), respectively. From ROC curves, 185.3 ng/mL as the optimal cut-off value of serum HA for diagnosis of significant fibrosis, giving its sensitivity, specificity, PPV, NPV, LR+, LR- and AC of 84.2%, 83.3%, 90.6%, 73.5%, 5.04, 0.19 and 83.9, respectively. While 132.7 ng/mL was the optimal cut-off value of serum LN, the sensitivity, specificity, PPV, NPV, LR+, LR- and AC were 71.9%, 80.0%, 87.2%, 60.0%, 3.59%, 0.35% and 74.7, respectively. Combinations of HA and LN by serial tests showed a perfect specificity and PPV of 100%, at the same time sensitivity declined to 63.2% and LR+ increased to 18.9, while parallel tests revealed a good sensitivity of 94.7%, NPV to 86.4%, and LR- declined to 0.08.

CONCLUSIONS

Serum HA and LN concentrations showed positive correlation with the stages of liver fibrosis. Detection of serum HA and LN in predicting significant fibrosis showed good diagnostic performance, which would be further optimized by combination of the two indices. HA and LN would be clinically useful serum markers for predicting significant fibrosis in patients with chronic hepatitis B, when liver biopsy is contraindicated.

摘要

目的

本研究旨在评估血清透明质酸（HA）和层粘连蛋白（LN）作为预测慢性乙型肝炎（CHB）患者显著纤维化的血清标志物的诊断性能。

方法

采用放射免疫分析法检测 87 例慢性乙型肝炎患者和 19 名献血者的血清 HA 和 LN 水平。根据 Metavir 评分系统确定肝纤维化分期。通过接收者操作特征（ROC）曲线评估所有指标的诊断性能。

结果

血清 HA 和 LN 浓度随肝纤维化分期显著升高，与肝纤维化分期呈正相关（HA：r = 0.875，p < 0.001；LN：r = 0.610，p < 0.001）。F2-4 组与 F0-F1 组（p < 0.001）和对照组（p < 0.001）之间的血清 HA 和 LN 水平有显著差异。根据 ROC 曲线，185.3ng/ml 为血清 HA 诊断显著纤维化的最佳截断值，其敏感性、特异性、阳性预测值、阴性预测值、优势比、劣势比和曲线下面积分别为 84.2%、83.3%、90.6%、73.5%、5.04、0.19 和 83.9。而血清 LN 的最佳截断值为 132.7ng/ml，其敏感性、特异性、阳性预测值、阴性预测值、优势比、劣势比和曲线下面积分别为 71.9%、80.0%、87.2%、60.0%、3.59%、0.35%和 74.7。HA 和 LN 的串联检测组合具有完美的特异性和阳性预测值 100%，同时敏感性降至 63.2%，优势比增至 18.9；而并联检测具有 94.7%的良好敏感性、86.4%的阴性预测值和 0.08 的劣势比。