Xu L, Zhong Y, Su S T, Liu Y G, Lyu F N, Zhou X L, Ren J Q, Li P, Shi R F, Jiang Y, Fan J G, Mi Y Q
Tianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin 300192, China.
Yanqing County Hospital of Beijing (Yanqing hospital, the Third Hospital of Peking University), Beijing 102100, China.
Zhonghua Gan Zang Bing Za Zhi. 2020 Mar 20;28(3):247-253. doi: 10.3760/cma.j.cn501113-20191231-00486.
To investigate the application value of reactive oxygen species (ROS) and adiponectin (ADPN) in the judgment of liver inflammation in chronic hepatitis B virus infection combined with nonalcoholic fatty liver disease (NAFLD). A total of 159 cases with NAFLD (21 cases), chronic hepatitis B virus infection (57 cases), and chronic hepatitis B virus infection combined with NAFLD (81 cases) were collected between June 2016 to December 2018, and the visited patients diagnosis were confirmed by histopathological examination of the liver. ROS and ADPN level retained in serum was determined by enzyme-linked immunosorbent assay. Histopathological examination of liver tissue was used as the gold standard to discuss the diagnostic value of the serum in patients with chronic hepatitis B virus infection combined with NAFLD for the occurrence of nonalcoholic steatohepatitis. One-way analysis of variance was used for the comparison among multiple groups, and LSD-t test was used for pairwise comparison between groups. Measurement data for non-normal distributions were expressed as M (P25, P75). Comparisons between groups were performed using the Mann-Whitney U or Kruskal-Wallis H test. Chi-square test was used to compare the count data between groups. Correlation analysis was performed using Spearman correlation analysis. Histopathological grouping of liver tissue was used as the gold standard, and the area under the receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the regression formula. (1) In patients with chronic hepatitis B virus infection combined with NAFLD, the levels of ROS in the non-hepatic steatosis group and the mild hepatic steatosis group were significantly lower than those in the moderate and severe hepatic steatosis group, while the ADPN level in the non-hepatic steatosis group was significantly higher than liver steatosis group, < 0.05. (2) The results of correlation analysis showed that ROS was significantly correlated with NAS score, change in the degree of fatty liver and lobular inflammation (all < 0.05).There was a significant negative correlation between ADPN and the change in the degree of fatty liver ( < 0.05). (3) Logistic regression analysis results showed that the diagnostic formula for chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis was 0.02 × controlled attenuation index + 0.584 × white blood cells/10(9) + 0.587 × ROS-10.982. The area under receiver operating characteristic curve of the subject was = 0.896. The sensitivity, specificity, positive and negative predictive value were 97.1%, 71.2%, 64.2%, and 97.9%. ADPN and ROS have certain reference value in differentiating the change in the degree of fatty liver and inflammation in chronic hepatitis B virus infection combined with NAFLD and the diagnostic formula has higher application value in the diagnosis and exclusion of chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis.
探讨活性氧(ROS)和脂联素(ADPN)在慢性乙型肝炎病毒感染合并非酒精性脂肪性肝病(NAFLD)患者肝脏炎症判断中的应用价值。收集2016年6月至2018年12月期间共159例NAFLD患者(21例)、慢性乙型肝炎病毒感染患者(57例)以及慢性乙型肝炎病毒感染合并NAFLD患者(81例),所有就诊患者均经肝脏组织病理学检查确诊。采用酶联免疫吸附测定法测定血清中ROS和ADPN水平。以肝脏组织病理学检查为金标准,探讨血清学指标对慢性乙型肝炎病毒感染合并NAFLD患者非酒精性脂肪性肝炎发生情况的诊断价值。多组间比较采用单因素方差分析,组间两两比较采用LSD-t检验。非正态分布的计量资料以M(P25,P75)表示。组间比较采用Mann-Whitney U检验或Kruskal-Wallis H检验。计数资料组间比较采用χ²检验。采用Spearman相关分析进行相关性分析。以肝脏组织病理学分组为金标准,采用受试者工作特征曲线下面积评估回归公式的诊断效能。(1)在慢性乙型肝炎病毒感染合并NAFLD患者中,非肝脂肪变性组和轻度肝脂肪变性组的ROS水平显著低于中度和重度肝脂肪变性组,而非肝脂肪变性组的ADPN水平显著高于肝脂肪变性组,P<0.05。(2)相关性分析结果显示,ROS与NAS评分、脂肪肝程度变化和小叶炎症均显著相关(均P<0.05)。ADPN与脂肪肝程度变化呈显著负相关(P<0.05)。(3)Logistic回归分析结果显示,慢性乙型肝炎病毒感染合并非酒精性脂肪性肝炎的诊断公式为0.02×控制衰减指数+0.584×白细胞/10⁹+0.587×ROS-10.982。受试者工作特征曲线下面积为0.896。灵敏度、特异度、阳性预测值和阴性预测值分别为97.1%、71.2%、64.2%和97.9%。ADPN和ROS在鉴别慢性乙型肝炎病毒感染合并NAFLD患者脂肪肝程度和炎症变化方面具有一定参考价值,且该诊断公式在慢性乙型肝炎病毒感染合并非酒精性脂肪性肝炎的诊断及排除方面具有较高应用价值。