Zhang Yazhen, Xu Aifang, Jin Yujiao, Gao Jing, He Jiahui
Department of Clinical Laboratory, Hangzhou Xixi Hospital, Hangzhou Sixth People's Hospital, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Department of Pathology, Hangzhou Xixi Hospital, Hangzhou Sixth People's Hospital, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2025 Jun 27;104(26):e43064. doi: 10.1097/MD.0000000000043064.
There is a lack of reliable serum markers to reflect the fibrosis stage and necroinflammation grade in autoimmune hepatitis (AIH) patients. In this study, we investigated the diagnostic potential of a noninvasive serum marker, Golgi protein 73 (GP73), for fibrosis and inflammation in AIH patients. Serum GP73 concentrations were measured in a retrospective cohort of 79 patients with AIH who underwent liver biopsy. The receiver operating characteristic curve was constructed to compare the diagnostic value of GP73, liver stiffness and other 2 serum diagnostic models, namely the aspartate aminotransferase to platelet ratio index and fibrosis-4, for significant liver fibrosis and advanced fibrosis. It also compared the predictive value of GP73 with alanine aminotransferase (ALT) and aspartate aminotransferase (AST) for moderate and severe liver necroinflammation. The results showed that serum GP73 level gradually increased with the stage of liver fibrosis or inflammation. The area under the curve (AUC) of GP73 for the diagnosis of significant and severe hepatic fibrosis was 0.684 (95% confidence interval [CI], 0.547-0.820; P = .027) and 0.773 (95% CI, 0.665-0.882; P < .001) respectively. Although the diagnostic efficacy of GP73 was lower than that of liver stiffness, the diagnostic efficacy for advanced fibrosis was slightly better than that of the aspartate aminotransferase to platelet ratio index (AUC, 0.698; 95% CI, 0.578-0.817; P = .003) and fibrosis-4 (AUC, 0.746; 95% CI, 0.632-0.860; P < .001). In addition, serum GP73 had high specificity for the diagnosis of moderate and severe necroinflammation, with AUC of 0.841 (95% CI, 0.738-0.943; P = .011) and 0.783 (95%CI, 0.683-0.882; P < .001), which were better than ALT and AST. Multivariate ordinal logistic regression showed that elevated serum GP73 level was an independent risk factor for necroinflammation in AIH patients (odds ratio, 1.021; 95%CI, 0.007-0.036; P = .004). In conclusion, we found that serum GP73 has good diagnostic value for advanced liver fibrosis in AIH and is a potential auxiliary serum diagnostic marker for liver fibrosis. And GP73 can be used as a reliable and simple noninvasive marker for grading hepatic inflammation with high specificity and better diagnostic efficacy than ALT and AST.
目前缺乏可靠的血清标志物来反映自身免疫性肝炎（AIH）患者的纤维化阶段和坏死性炎症分级。在本研究中，我们调查了一种非侵入性血清标志物高尔基体蛋白73（GP73）对AIH患者纤维化和炎症的诊断潜力。对79例接受肝活检的AIH患者的回顾性队列测定了血清GP73浓度。构建了受试者工作特征曲线，以比较GP73、肝脏硬度及其他两种血清诊断模型（即天冬氨酸转氨酶与血小板比值指数和Fibrosis-4）对显著肝纤维化和进展性纤维化的诊断价值。还比较了GP73与丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）对中度和重度肝脏坏死性炎症的预测价值。结果显示，血清GP73水平随肝纤维化或炎症阶段逐渐升高。GP73诊断显著和重度肝纤维化的曲线下面积（AUC）分别为0.684（95%置信区间[CI]，0.547 - 0.820；P = 0.027）和0.773（95%CI，0.665 - 0.882；P < 0.001）。虽然GP73的诊断效能低于肝脏硬度，但对进展性纤维化的诊断效能略优于天冬氨酸转氨酶与血小板比值指数（AUC，0.698；95%CI，0.578 - 0.817；P = 0.003）和Fibrosis-4（AUC，0.746；95%CI，0.632 - 0.860；P < 0.001）。此外，血清GP73对中度和重度坏死性炎症的诊断具有高特异性，AUC分别为0.841（95%CI，0.738 - 0.943；P = 0.011）和0.783（95%CI，0.683 - 0.882；P < 0.001），优于ALT和AST。多变量有序逻辑回归显示，血清GP73水平升高是AIH患者坏死性炎症的独立危险因素（比值比，1.021；95%CI，0.007 - 0.036；P = 0.004）。总之，我们发现血清GP73对AIH患者的进展性肝纤维化具有良好的诊断价值，是肝纤维化潜在的辅助血清诊断标志物。并且GP73可作为一种可靠且简单的非侵入性标志物用于肝脏炎症分级，具有高特异性，诊断效能优于ALT和AST。
