评估血清高尔基体蛋白73作为慢性乙型肝炎病毒感染患者显著肝纤维化诊断生物标志物的价值。
Assessment of serum Golgi protein 73 as a biomarker for the diagnosis of significant fibrosis in patients with chronic HBV infection.
作者信息
Cao Z, Li Z, Wang Y, Liu Y, Mo R, Ren P, Chen L, Lu J, Li H, Zhuang Y, Liu Y, Wang X, Zhao G, Tang W, Xiang X, Wang H, Cai W, Liu L, Zhu C, Bao S, Xie Q
机构信息
Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Hepatology, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China.
出版信息
J Viral Hepat. 2017 Nov;24 Suppl 1:57-65. doi: 10.1111/jvh.12786.
Transient elastography (TE) is accurate in staging fibrosis noninvasively. However, a reliable serum biomarker with comparable accuracy is also important, especially when TE is unreliable/unavailable. Therefore, we aimed to evaluate the diagnostic performance of serum Golgi protein 73 (GP73) for significant fibrosis in patients with chronic HBV infection. A total of 801 patients with chronic liver disease (CLD; 492 chronic HBV infection and 309 non-HBV liver disease) with liver biopsy performance were enrolled. Healthy controls (n = 180) and hepatocellular carcinoma (HCC) patients (n = 85) were included for comparisons. Liver biopsy was used as the reference method for fibrosis staging. Serum GP73 level was measured in duplicate in double-blind fashion. Serum GP73 was highest in HCC but also significantly higher in chronic hepatitis B than in healthy controls. The elevation of serum GP73 in non-HCC patients was significantly associated with the presence of significant fibrosis independently of ALT level, liver stiffness (LS) value, inflammation grade and other confounding factors. The diagnostic performance of serum GP73 was accurate in antiviral-naïve HBV patients (area under the receiver operating curve [AUROC], 0.76 95% CI: 0.72-0.81) but not in patients with ongoing antiviral treatment (AUROC, 0.60). The utility of serum GP73 was also confirmed in non-HBV CLD (AUROC, 0.80 95% CI: 0.75-0.85). Serum GP73 was comparable to LS (AUROC, 0.78 95% CI: 0.73-0.82) and significantly better than AST to platelet ratio index (APRI) (AUROC, 0.67 95% CI: 0.62-0.72) and FIB-4 (AUROC, 0.68 95% CI: 0.63-0.73). In conclusion, serum GP73 is an accurate serum marker for significant fibrosis in chronic HBV infection, with higher accuracy than APRI and FIB-4. Serum GP73 is potentially a complementary tool for TE when evaluating the necessity of antiviral treatment, particularly in patients without definite antiviral indication.
瞬时弹性成像（TE）在无创性肝纤维化分期方面具有准确性。然而，一种具有可比准确性的可靠血清生物标志物也很重要，尤其是当TE不可靠/无法使用时。因此，我们旨在评估血清高尔基体蛋白73（GP73）对慢性HBV感染患者显著肝纤维化的诊断性能。共纳入801例有肝活检结果的慢性肝病（CLD）患者（492例慢性HBV感染和309例非HBV肝病）。纳入健康对照者（n = 180）和肝细胞癌（HCC）患者（n = 85）进行比较。肝活检用作肝纤维化分期的参考方法。以双盲方式对血清GP73水平进行重复测量。血清GP73在HCC中最高，但在慢性乙型肝炎中也显著高于健康对照者。在非HCC患者中，血清GP73升高与显著肝纤维化的存在显著相关，且独立于ALT水平、肝脏硬度（LS）值、炎症分级和其他混杂因素。血清GP73在未接受抗病毒治疗的HBV患者中诊断性能准确（受试者操作特征曲线下面积[AUROC]，0.76；95%置信区间：0.72 - 0.81），但在接受抗病毒治疗的患者中不准确（AUROC，0.60）。血清GP73在非HBV CLD中的效用也得到证实（AUROC，0.80；95%置信区间：0.75 - 0.85）。血清GP73与LS相当（AUROC，0.78；95%置信区间：0.73 - 0.82），且显著优于天冬氨酸氨基转移酶与血小板比值指数（APRI）（AUROC，0.67；95%置信区间：0.62 - 0.72）和FIB - 4（AUROC，0.68；95%置信区间：0.63 - 0.73）。总之，血清GP73是慢性HBV感染中显著肝纤维化的准确血清标志物，其准确性高于APRI和FIB - 4。在评估抗病毒治疗必要性时，血清GP73可能是TE的一种补充工具，尤其是在没有明确抗病毒指征的患者中。
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