摘要
目的探究血清高尔基体蛋白73(GP73)及基于其构建的诊断模型对丙型肝炎肝硬化患者的诊断价值。方法回顾性收集2010年1月至2017年12月在解放军总医院第五医学中心就诊的271例慢性丙型肝炎病毒感染者为研究对象,其中肝炎患者126例,肝硬化患者145例。患者均进行血清GP73检查和基于肝脏瞬时弹性成像的肝脏硬度测定(LSM),并收集血常规、肝功能、凝血功能等相关指标。采用受试者操作特征曲线(ROC)评估GP73对肝硬化的诊断效能,并与天冬氨酸转氨酶/血小板比值指数(APRI)、FIB-4指数(FIB-4)及LSM的诊断价值进行比较,明确GP73的诊断价值后,通过logistic回归性分析建立基于血清学指标的代偿期丙型肝炎肝硬化诊断模型。结果GP73、LSM、FIB-4和APRI诊断代偿期丙型肝炎肝硬化的受试者操作特征曲线下面积(AUC)依次为0.923、0.839、0.836和0.800,以GP73的诊断效能最优(P<0.001)。LSM、GP73联用可将肝硬化的诊断灵敏度提高到97.24%。多因素logistic回归分析揭示GP73、年龄、血小板是肝硬化的独立预测因素,并据此建立了代偿期丙型肝炎肝硬化诊断模型(GAP):LogitP=1/[1+exp(6.145+0.013×血小板-0.059×年龄-0.059×GP73)],该模型诊断代偿期肝硬化的AUC为0.944,在最佳cut-off值0.56时的灵敏度和特异度分别为84.03%、92.06%,诊断效能也优于APRI、FIB-4、LSM以及GP73单用(P值均<0.05)。结论GP73是诊断丙型肝炎代偿期肝硬化的可靠的血清生物标志物,基于GP73、血小板计数及年龄构建的代偿期丙型肝炎肝硬化的GAP诊断模型可使诊断效能进一步改善,有助于代偿期丙型肝炎肝硬化患者的诊断。
Objective To explore the diagnostic value and model of serum Golgi protein 73(GP73)in patients with hepatitis C cirrhosis.Methods 271 cases with chronic hepatitis C virus infection who were treated in the Fifth Medical Center of PLA General Hospital from January 2010 to December 2017 were retrospectively collected as the research objects,including 126 cases with hepatitis and 145 cases with liver cirrhosis.Serum GP73 and liver stiffness measurement(LSM)based on transient elastography test were performed in all patients.Simultaneously,blood routine,liver function,coagulation function and other related indicators were collected.GP73 diagnostic efficiency for liver cirrhosis was evaluated by receiver operating characteristic curve(ROC).GP73 diagnostic value was clarified after comparison with aspartate aminotransferase/platelet ratio index(APRI),FIB-4 index(FIB-4)and LSM.Compensated hepatitis C virus-related cirrhosis diagnostic model based on serological index was established by logistic regression analysis.Results The area under the receiver operating characteristic curve(AUC)of GP73,LSM,FIB-4 and APRI in the diagnosis of compensated hepatitis C virus-related cirrhosis were 0.923,0.839,0.836 and 0.800 respectively,and GP73 had the best diagnostic efficiency(P<0.001).LSM and GP73 combined use had improved the diagnostic sensitivity of cirrhosis to 97.24%.Multivariate logistic regression analysis revealed that GP73,age,and platelets were independent predictors of cirrhosis.Compensated hepatitis C virus-related cirrhosis diagnostic model(GAP)was established based on the result:LogitP=1/[1+exp(6.145+0.013×platelet-0.059×age-0.059×GP73)].AUC model for diagnosing compensated liver cirrhosis was 0.944,and the optimal cut-off value was 0.56,with sensitivity and specificity of 84.03%and 92.06%,respectively,and the diagnostic efficiency of this model was better than that of APRI,FIB-4,LSM and GP73 alone(P<0.05).Conclusion GP73 is a reliable serum biomarker for the diagnosis of compensated hepatitis C virus-related cirrho
作者
王鹏飞
刘树红
钱相君
翟相威
文夏杰
姚明解
赵景民
鲁凤民
Wang Pengfei;Liu Shuhong;Qian Xiangjun;Zhai Xiangwei;Wen Xiajie;Yao Mingjie;Zhao Jingmin;Lu Fengmin(Department of Epidemiology and Statistics,College of Public Health Zhengzhou University,Zhengzhou 450001,China;Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Department of Microbiology&Infectious Disease Center,School of Basic Medical Sciences,Peking University Health Science Center,Beijing 100191,China;Department of Human Anatomy and Histology and Embryology,School of Basic Medicine,Peking University,Beijing 100191,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2022年第8期879-884,共6页
Chinese Journal of Hepatology
基金
国家自然科学基金资助项目(81902115,82272433)
北京市科学技术委员会资助项目(Z161100000116047,D161100002716003)。
