Simple serum markers for significant liver inflammation in chronic hepatitis B patients with an alanine aminotransferase level lower than 2 times upper limit of normal
-
摘要: 目的探索有效预测ALT<2倍正常值上限(ULN)的慢性乙型肝炎(CHB)患者显著肝脏炎症的简易血清标志物。方法回顾性纳入278例ALT<2×ULN(ULN=40 U/L)的CHB患者。显著肝脏炎症定义为炎症程度(G)≥2。计量资料满足正态分布的组间比较采用t检验;不满足正态分布的采用Kruskal-Wallis秩和检验,计数资料组间比较采用χ2检验。多因素回归分析筛查ALT<2×ULN的CHB患者显著肝脏炎症的独立预测因素。受试者工作特征(ROC)曲线评估血清标志物对显著肝脏炎症的诊断价值。结果 278例患者中175例(62.9%)无显著肝脏炎症(G01组);103例(37.1%)伴显著肝脏炎症(G24组)。2组在ALT、AST、ALP、GGT、白蛋白(Alb)、球蛋白(Glb)、凝血酶原时间(PT)、血小板(PLT)、中性粒细胞绝对数(ANC)、透明质酸(HA)、甘胆酸(CG)、Ⅲ型前胶原(PCⅢ)和IV型胶原(ⅣC)等方面的差异均有统计学意义(P值均<0.05)。单因素回归分析发现ALT、AST、ALP、GGT、G...Abstract: Objective To investigate the simple serum markers for significant liver inflammation in chronic hepatitis B(CHB) patients with an alanine aminotransferase(ALT) level of < 2 times upper limit of normal(ULN).Methods The clinical data of 278 CHB patients with ALT < 2 × ULN(ULN = 40 U / L) were analyzed retrospectively.Significant liver inflammation was defined as a liver inflammatory activity grade(G) ≥2.The t- test was used for comparison of normally distributed continuous data between groups,and the Kruskal- Wallis rank sum test was used for non- normally distributed continuous data;the chi- square test was used for comparison of categorical data between groups.Multivariate logistic regression analysis was used to identify independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN.The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of serum markers in significant liver inflammation.Results Of the 278 CHB patients enrolled,175(62.9%) had no significant liver inflammation(G0- 1group) and 103(37.1%) had significant liver inflammation(G2- 4 group).There were significant differences in ALT,aspartate aminotransferase,alkaline phosphatase,gamma- glutamyl transpeptidase(GGT),albumin,globulin,prothrombin time(PT),platelet,absolute neutrophil count,hyaluronic acid(HA),glycocholic acid,precollagen Ⅲ,and collagen type Ⅳ(ⅣC) between the two groups(all P< 0.05).The multivariate regression analysis showed that GGT,PT,ⅣC,and HA were independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN(OR = 1.015,1.600,1.151,and 1.014,P = 0.008,0.021,0.003,and 0.018).The areas under the ROC curve for GGT,PT,IVC,and HA to diagnose significant liver inflammation were 0.804,0.722,0.707,and 0.632,respectively.The cut- off value of 48.5 U / L for GGT to predict significant liver inflammation had a specificity of 90.3% and a negative predictive value of 74.6%.Conclusion GGT,PT,IVC,and HA are independent predictors for significant liver inflammation in CHB patients with ALT < 2 × ULN,among which GGT has the highest predictive value.
-
Key words:
- hepatitis B /
- chronic /
- alanine aminotransferase /
- γ-glutamyltranspeptidase
-
[1] RAPTOPOULOU M,PAPATHEODORIDIS G,ANTONIOU A,et al.Epidemiology,course and disease burden of chronic hepatitis Bvirus infection.HEPNET study for chronic hepatitis B:a multicentre Greek study[J].J Viral Hepat,2009,16(3):195-202. [2]LIANG P,ZU J,YIN J,et al.The independent impact of newborn hepatitis B vaccination on reducing HBV prevalence in China,1992-2006:a mathematical model analysis[J].J Theor Biol,2015,386:115-121. [3]GUO TZ,HAN LX,LUO Y,et al.Risk factors of liver cancer in patients with hepatitis B virus infection[J].Int J Virol,2016,23(1):26-28.(in Chinese)郭铁志,韩立新,罗研,等.乙型肝炎病毒感染患者肝癌发病的影响因素研究[J].国际病毒学杂志,2016,23(1):26-28. [4] WU JF,CHANG MH.Natural history of chronic hepatitis B virus infection from infancy to adult life-the mechanism of inflammation triggering and long-term impacts[J].J Biomed Sci,2015,22(1):92. [5]LIAW YF,KAO JH,PIRATVISUTH T,et al.Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2012 update[J].Hepatol Int,2012,6(3):531-561. [6]MARTIN P,LAU DT,NGUYEN MH,et al.A Treatment Algorithm for the Management of Chronic Hepatitis B Virus Infection in the United States:2015 Update[J].Clin Gastroenterol Hepatol,2015,13(12):2071-2087. [7]PARK JY,PARK YN,KIM DY,et al.High prevalence of significant histology in asymptomatic chronic hepatitis B patients with genotype C and high serum HBV DNA levels[J].J Viral Hepat,2008,15(8):615-621. [8] CHEONG JY,KIM D J,HWANG SG,et al.Serum markers for necroinflammatory activity in patients with chronic viral hepatitis and normal or mildly elevated aminotransferase levels[J].Liver Int,2011,31(9):1352-1358. [9] ALAM MM,MAHTAB MA,AKBAR SM,et al.Hepatic necroinflammation and severe liver fibrosis in patients with chronic hepatitis B with undetectable HBV DNA and persistently normal alanine aminotransferase[J].Bangladesh Med Res Counc Bull,2014,40(3):92-96. [10]XIANG TX,TAO XP,LI XN,et al.Study on interferon gamma spot level of chronic hepatitis B infection in different immune stages and optimal opportunity of antiviral treatment in low levels of ALT patients[J].Int J Virol,2015,22(3):157-161.(in Chinese)向天新,陶学萍,李细女,等.慢性乙肝病毒感染者不同免疫阶段IFN-γ斑点水平及其他低丙氨酸氨基转移酶抗病毒治疗中的作用[J].国际病毒学杂志,2015,22(3):157-161. [11] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B(2010 verson)[J].J Clin Hepatol,2011,27(1):Ⅰ-ⅩⅥ.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].临床肝胆病杂志,2011,27(1):Ⅰ-ⅩⅥ. [12]Chinese Society of Hepatology and Chinese Society of Infectious Diseases and Parasitic Disease,Chinese Medical Association.Guideline:prevention and treatment of viral hepatitis(draft)[J].Chin JHepatol,2000,8(6):324-329.(in Chinese)中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329. [13]MYERS RP,TAINTURIER MH,RATZIU V,et al.Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B[J].J Hepatol,2003,39(2):222-230. [14]BENINI F,PIGOZZI MG,BAISINI O,et al.Increased serum gamma-glutamyl-transpeptidase concentration is associated with nonalcoholic steatosis and not with cholestasis in patients with chronic hepatitis C[J].J Gastroenterol Hepatol,2007,22(10):1621-1626. [15] KRISHNAMURTHY HA.The serum gamma glutamyl transpeptidasea non invasive diagnostic bio marker of chronic anicteric non alcoholic liver diseases[J].J Clin Diagn Res,2013,7(4):691-694.
本文二维码
计量
- 文章访问数: 2261
- HTML全文浏览量: 22
- PDF下载量: 511
- 被引次数: 0