血清sP-selectin、sICAM-1和免疫球蛋白检测对乙肝肝硬化预后评估的意义

目的：旨在探讨血清sP-selectin、sICAM-1和免疫球蛋白检测对乙肝肝硬化预后评估的意义。方法：选取池州市人民医院于2014年1月~2016年12月收治的162例乙肝肝硬化患者作为研究对象，分别测定患者血清可溶性P-选择素(sP-selectin)、可溶性细胞间黏附分子-1(sICAM-1)、免疫球蛋白和相关血清指标。比较不同肝硬化患者和肝癌患者血清指标差异性，Pearson分析血清可溶性P-选择素(sP-selectin)、可溶性细胞间黏附分子-1(sICAM-1)、免疫球蛋白和相关血清指标相关性，logistic多因素回归分析肝硬化转肝癌危险因素，受试者工作特征（ROC）曲线评价OR>1参数对肝硬化转肝癌预测价值。结果：原发性肝癌患者sP-selectin、sICAM-1、IgM、IgG、IgA显著高于代偿期肝硬化和失代偿期肝硬化患者（P<0.05）。失代偿期肝硬化患者sP-selectin、sICAM-1、IgM、IgG、IgA显著高于代偿期肝硬化患者（P<0.05）。不同Child-Pugh分级肝硬化患者中，C级患者sP-selectin、sICAM-1、IgM、IgG、IgA显著高于B级和A级患者（P<0.05）。B级患者sP-selectin、sICAM-1、IgM、IgG、IgA显著高于A级患者（P<0.05）。多发癌灶患者和单发癌灶原发性肝癌患者sP-selectin、sICAM-1和免疫球蛋白表达差异无统计学意义（P>0.05）。Ⅱ期原发性肝癌患者sP-selectin、sICAM-1和免疫球蛋白显著高于Ⅰ期患者（P<0.05）。肝硬化患者sP-selectin、sICAM-1、免疫球蛋白之间均互为正相关性（P<0.05）。以肝硬化是否转原发性肝癌为因变量进行多因素Logistic回归分析，结果显示，ALT、AST、sP-selectin、sICAM-1、IgM、IgG、IgA均是肝硬化转原发性肝癌的危险因素。ROC曲线分析可得，sICAM-1和sP-selectin诊断肝硬化转肝癌敏感性和特异性均高于其他因素。结论：血清sP-selectin、sICAM-1对乙肝肝硬化预后评估具有较高临床诊断精度，对肝硬化转原发性肝癌的诊断特异度、敏感度高于单纯免疫球蛋白检测，故其联合检测诊断肝硬化预后值得临床推广。

Prognostic significance of serum sP-selectin,sICAM-1 and immunoglobulin in patients with hepatitis B cirrhosis

Objective: To investigate the significance of serum sP-selectin,sICAM-1 and immunoglobulin in the prognosis of hepatitis B cirrhosis. Methods: 162 cases of hepatitis B patients with cirrhosis were treated as the research object in clinical laboratory of Chizhou People′s Hospital from January 2014 to December 2016,and detected in the serum of soluble P-selectin(sP-selectin),soluble intercellular adhesion molecule-1(sICAM-1),immunoglobulin and serum related index. Comparison of liver cirrhosis and liver cancer patients mean difference, Pearson analysis of serum soluble P-selectin(sP-selectin),soluble intercellular adhesion molecule-1(sICAM-1),the correlation of immunoglobulin and serum indexes,logistic regression analysis of risk factors of liver cirrhosis to hepatocellular carcinoma,the receiver operating characteristic(ROC)OR>1 parametric curve evaluation of predictive value of hepatocellular carcinoma to liver cirrhosis Results: The levels of sP-selectin,sICAM-1,IgM,IgG and IgA in patients with primary liver cancer were significantly higher than those in compensated cirrhosis and decompensated liver cirrhosis(P<0.05).The levels of sP-selectin,sICAM-1,IgM,IgG and IgA in patients with decompensated cirrhosis were significantly higher than those in decompensated liver cirrhosis(P<0.05).sP-selectin,sICAM-1,IgM,IgG,IgA were significantly higher in patients with grade C and grade B(P<0.05)in patients with different grades of cirrhosis.SP-selectin,sICAM-1,IgM,IgG,IgA were significantly higher in patients with grade B(P<0.05).There was no significant difference in the expressions of sP-selectin,sICAM-1 and immunoglobulin in patients with multiple foci of carcinoma and primary hepatocellular carcinoma(P>0.05).SP-selectin,sICAM-1 and immunoglobulin in patients with stage Ⅱ primary liver cancer were significantly higher than those in stage Ⅰ(P<0.05).There was a positive correlation between sP-selectin,sICAM-1 and immunoglobulin in patients with liver cirrhosis(P<0.05).In liver cirrhosis was the transfer of primary liver cancer as the dependent variable for Logistic regression analysis, the results showed that ALT,AST,sP-selectin,sICAM-1,IgM,IgG,IgA were risk factors of liver cirrhosis to hepatocellular carcinoma.ROC curve analysis showed that the sensitivity and specificity of sICAM-1 and sP-selectin in diagnosis of liver cirrhosis were higher than other factors.Conclusion: Serum sP-selectin,sICAM-1 has a higher accuracy of clinical diagnosis of hepatitis B cirrhosis prognosis evaluation,diagnostic specificity and sensitivity of liver cirrhosis to hepatocellular carcinoma was higher than that of simple detection of immunoglobulin,the combined detection in the diagnosis of liver cirrhosis is worthy of clinical prognosis.