壳多糖酶3样蛋白1在肝纤维化分期中的诊断价值

目的探讨壳多糖酶3样蛋白1(CHI3L1)在肝纤维化分期中的诊断价值。方法选择2016年1月至2018年7月在该院就诊的400例慢性肝病患者和60例健康对照者为研究对象。检测所有研究对象CHI3L1、透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原N端肽(PⅢNP)和Ⅳ型胶原(CⅣ)水平,采用受试者工作特征曲线(ROC曲线)分析CHI3L1、HA、LN、PⅢNP、CⅣ对肝纤维化分期的诊断价值。结果慢性肝病患者血清CHI3L1水平随着肝纤维化分期的增加而升高(H=165.543,P<0.001)。CHI3L1诊断有肝纤维化和无肝纤维化的曲线下面积(AUC)为0.830,阈值为81.6 ng/mL,灵敏度为59.30%,特异度为95.45%。CHI3L1诊断显著肝纤维化的AUC为0.847,高于HA(0.703)、LN(0.639)、PⅢNP(0.743)、CⅣ(0.774),差异有统计学意义(P<0.05)。CHI3L1单独检测诊断显著肝纤维化的阈值为85.1 ng/mL,灵敏度和特异度分别为72.96%和84.07%。CHI3L1单独检测诊断重度肝纤维化的阈值为94.6 ng/mL,灵敏度和特异度分别为75.86%和79.62%,AUC为0.845(95%CI:0.806~0.878),高于HA(0.677)、LN(0.662)、PⅢNP(0.767)和CⅣ(0.789),差异有统计学意义(P<0.05)。结论血清CHI3L1是辅助诊断慢性肝病患者肝脏纤维化程度的良好指标,具有较好的临床应用价值。

Clinical values of chitinase 3 like protein 1 in the diagnosis of liver fibrosis in patients with chronic liver diseases

Objective To explore the clinical values of chitinase 3 like protein 1(CHI3L1)in the diagnosis of liver fibrosis in patients with chronic liver diseases.Methods A total of 400 chronic patients with chronic liver diseases and 60 healthy controls were enrolled from January 2016 to July 2018 at Mengchao Hepatobiliary Hospital of Fujian Medical University.The levels of CHI3L1,hyaluronic acid(HA),laminin(LN),N-terminal propeptide of collagenⅢ(PⅢNP)and collagen typeⅣ(CⅣ)were detected.Receiver operating characteristic(ROC)curve was used to analyze the value of CHI3L1,HA,LN,PⅢNP and CⅣin diagnosing liver fibrosis.Results The serum levels of CHI3L1 in patients with chronic liver diseases increased with the their degrees of liver fibrosis(H=165.543,P<0.001).Area under curve(AUC)of CHI3L1 in diagnosing patients with liver fibrosis or not was 0.830,and the cutoff value was 81.6 ng/mL,the sensitivity and specificity were 59.30%and 95.45%respectively.Cutoff point of single detection of CHI3L1 in diagnosing significant hepatic fibrosis was 85.1 ng/mL,sensitivity and specificity were 72.96%and 84.07%respectively with an AUC of 0.847,which was significantly higher than that of HA(0.703),LN(0.639),PⅢNP(0.743)and CⅣ(0.774),differences were statistically significant(P<0.05).Cutoff point of single detection of CHI3L1 in diagnosing severe hepatic fibrosis was 94.6 ng/mL,sensitivity and specificity were 75.86%and 79.62%respectively.And AUC was 0.845(95%CI:0.806-0.878),which was significantly higher than that of HA(0.677),LN(0.662),PⅢNP(0.767)and of CⅣ(0.789),differences were statistically significant(P<0.05).Conclusion Serum CHI3L1 could aid the diagnosis of liver fibrosis in chronic liver diseases and have good clinical utilities.