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

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。

Correlation of serum sST2 and liver function,platelet level and Ishak score in chronic hepatitis B patients

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.