慢性乙型肝炎患者血清sST2与肝功能、血小板水平及Ishak评分的相关性

doi:10.3969/j.issn.1004-583X.2021.11.003

摘要/Abstract

摘要：

目的观察慢性乙型肝炎(CHB)患者血清可溶性生长刺激表达基因2蛋白(sST2)的表达,并分析其与肝功能、血小板(PLT)水平、Ishak评分的相关性。方法前瞻性地选取2018年12月至2020年12月大连市第六人民医院收治CHB患者190例,依据Ishak分为无纤维化(29例),纤维化(124例)、肝硬化(37例);另择同时期体检正常30例作为对照组。检测天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)、sST2、PLT水平,计算APRI,并分析。结果 4组受试者血清sST2、AST、ALT、ALB、TBIL、APRI、PLT比较差异显著(P<0.05)。无纤维化、纤维化及肝硬化患者血清sST2、AST、ALT、TBIL均显著高于对照组(P<0.05),ALB均显著低于对照组(P<0.05);肝硬化患者血清sST2、AST、ALT、TBIL均显著高于无纤维化、纤维化患者(P<0.05),ALB均显著低于无纤维化、纤维化患者(P<0.05),PLT显著低于对照组及无纤维化、纤维化患者(P<0.05)。Pearson结果显示,CHB患者sST2与AST、ALT、ALB、TBIL、PLT、APRI均呈相关(r=0.939、0.918、-0.816、0.795、-0.469、0.933,P<0.05);Spearman结果显示,CHB患者血清sST2与Ishak评分呈正相关(r=0.885,P<0.05)。多元线性回归模型,血清AST、ALT、ALB、TBIL、PLT及Ishak评分均是影响血清sST2的因素。ROC曲线显示,血清sST2、APRI及联合诊断肝硬化的AUC为0.715、0.789、0.806,敏感度分别为0.700、0.780、0.810,特异度分别为0.903、0.847、0.855。结论血清sST2在CHB患者中异常升高,并随着肝纤维化的加重而升高;同时肝功能指标、PLT及Ishak评分均是血清sST2的影响因素,且血清sST2联合APRI可提高对CHB肝硬化的预测价值。

关键词: 乙型肝炎,慢性, 肝功能不全, 炎症, 血小板, 肝硬化

Abstract:

Objective To observe the expression of serum soluble suppression of tumorigenicity-2 (sST2) in patients with chronic hepatitis B (CHB), and to analyze the correlation of sST2 and liver function, platelet(PLT) and Ishak score. Methods Totally 190 inpatients with CHB who met the inclusion criteria were prospectively enrolled from December 2018 to December 2020 in Dalian Sixth People's Hospital. The patients were divided into no fibrosis (29 cases), fibrosis (124 cases), and cirrhosis (37 cases) according to Ishak inflammation score. Thirty healthy controls in the physical examination center during the same period were recruited. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), total bilirubin (TBIL), sST2 and PLT were detected, and APRI was counted. Results There were significant differences in serum sST2, AST, ALT, ALB, TBIL, APRI and PLT among four groups (P<0.05). Compared with controls, sST2, AST, ALT and TBIL in CHD patients were significantly higher (P<0.05), while serum ALB was significantly lower (P<0.05). Compared with patients with and without fibrosis, serum sST2, AST, ALT and TBIL of cirrhosis patients were significantly higher (P<0.05), while ALB and PLT were significantly lower (P<0.05). Compared with controls, PLT of cirrhosis patients was significantly lower (P<0.05). Pearson results showed that sST2 of CHB patients was closely related to AST, ALT, ALB, TBIL, PLT and APRI (r=0.939, 0.918, -0.816, 0.795, -0.469, 0.933, P<0.05). Spearman results showed that there was positive correlation between serum sST2 and Ishak score (r=0.885, P<0.05). Multivariate analysis showed that AST, ALT, ALB, TBIL, PLT, and Ishak score were influencing factors for sST2. The AUC values of the area under ROC curve of SST2, APRI and the combined diagnosis of cirrhosis were 0.715, 0.789 and 0.806. The sensitivity were 0.700, 0.780 and 0.810. The specificity 0.903, 0.847, 0.855, respectively. Conclusion For CHB patients, when serum sST2 abnormally elevates, liver fibrosis increases. At the same time, influencing factors for serum sST2 are liver function indexes. PLT and Ishak score, and serum sST2 combined with APRI can improve the predictive value of cirrhosis.

Key words: hepatitis B,chronic, hepatic insufficiency, inflammation, blood platelets, liver fibrosis

中图分类号:

R512.62

王园园, 程宁, 林海燕. 慢性乙型肝炎患者血清sST2与肝功能、血小板水平及Ishak评分的相关性[J]. 临床荟萃, 2021, 36(11): 976-980.

Wang Yuanyuan, Cheng Ning, Lin Haiyan. Correlation of serum sST2 and liver function, platelet level and Ishak score in chronic hepatitis B patients[J]. Clinical Focus, 2021, 36(11): 976-980.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.11.003

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I11/976

图/表 12

表1 4组基线资料比较

组别	例数	性别[例(%)]		年龄 ( $x -$ ±s,岁)	病程 ( $x -$ ±s,年)	合并病[例(%)]
组别	例数	男	女	年龄 ( $x -$ ±s,岁)	病程 ( $x -$ ±s,年)	糖尿病	高血压
无纤维化	29	17(58.62)	12(41.38)	43.31±6.85	5.21±2.01	6(20.69)	3(10.34)
纤维化	124	72(58.06)	52(41.94)	44.13±6.72	5.19±2.00	13(10.48)	12(9.68)
肝硬化	37	27(72.97)	10(27.03)	43.57±6.81	5.14±2.03	7(18.92)	5(13.51)
对照组	30	18(60.00)	12(40.00)	44.83±6.71	-	-	-
χ²/F值		0.038		0.318	0.014	2.251	0.012
P值		0.846		0.812	0.986	0.134	0.913

表1 4组基线资料比较

组别	例数	性别[例(%)]		年龄 ( $x -$ ±s,岁)	病程 ( $x -$ ±s,年)	合并病[例(%)]
组别	例数	男	女	年龄 ( $x -$ ±s,岁)	病程 ( $x -$ ±s,年)	糖尿病	高血压
无纤维化	29	17(58.62)	12(41.38)	43.31±6.85	5.21±2.01	6(20.69)	3(10.34)
纤维化	124	72(58.06)	52(41.94)	44.13±6.72	5.19±2.00	13(10.48)	12(9.68)
肝硬化	37	27(72.97)	10(27.03)	43.57±6.81	5.14±2.03	7(18.92)	5(13.51)
对照组	30	18(60.00)	12(40.00)	44.83±6.71	-	-	-
χ²/F值		0.038		0.318	0.014	2.251	0.012
P值		0.846		0.812	0.986	0.134	0.913

表2 4组生化检查项目比较($\bar{x}±s$)

组别	例数	sST2 (ng/ml)	AST (U/L)	ALT (U/L)	ALB (g/L)	TBIL (μmol/L)	PLT (×10⁹/L)	APRI
无纤维化	29	11.97±3.50^*	41.30±11.29^*	38.60±9.08^*	33.25±8.36^*	23.87±6.38^*	187.31±40.18	0.61±0.29^*
纤维化	124	19.28±5.10^*△	87.29±16.62^*△	79.42±14.53^*△	26.22±7.38^*△	49.62±13.41^*△	172.58±36.23^*	1.37±0.55^*△
肝硬化	37	37.61±9.32^*△#	189.77±32.22^*△#	177.87±29.02^*△#	16.31±5.54^*△#	78.11±14.37^*△#	148.79±34.32^*△#	3.49±1.40^*△#
对照组	30	6.23±1.11	21.57±6.49	18.11±4.19	36.55±9.11	19.99±5.29	198.31±43.26	0.29±0.13
F值		204.724	546.974	630.987	48.343	169.263	11.069	139.557
P值		0.000	0.000	0.000	0.000	0.000	0.000	0.000

图1 血清sST2与AST相关性

图2 血清sST2与ALT相关性

图3 血清sST2与ALB相关性

图4 血清sST2与TBIL相关性

图5 血清sST2与PLT相关性

图6 血清sST2与APRI相关性

图7 血清sST2与Ishak评分相关性

表3 CHB患者血清sST2的多元线性回归分析

变量	回归系数	标准误	t值	P值	OR值	95%CI
变量	回归系数	标准误	t值	P值	OR值	下限	上限
AST	0.184	0.025	7.247	0.000	0.928	0.134	0.235
ALT	0.168	0.011	15.124	0.000	0.792	0.146	0.190
ALB	-0.139	0.047	-2.937	0.004	-0.121	-0.232	-0.046
TBIL	0.394	0.022	17.976	0.000	0.795	0.351	0.437
PLT	-0.049	0.008	-6.131	0.000	-0.184	-0.065	-0.033
APRI	7.827	0.220	35.772	0.000	0.933	7.424	8.290
Ishak评分	0.165	0.010	16.314	0.000	0.778	0.145	0.185

表4 血清sST2、APRI对肝硬化的预测效能

变量	截断值	AUC	P值	敏感度	特异度	95%CI
变量	截断值	AUC	P值	敏感度	特异度	下限	上限
sST2	26.755 ng/ml	0.715	0.000	0.700	0.903	0.594	0.837
APRI	1.925	0.789	0.000	0.780	0.847	0.68	0.898
联合	8.965	0.806	0.000	0.810	0.855	0.704	0.907

图8 血清sST2、APRI联合预测肝硬化的ROC曲线

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