血清AFP对慢性乙型肝炎肝纤维化程度的预测价值

程婉秋; 管世鹤; 张浩; 杨凯; 陈治东; 邵璇璇

doi:10.3969/j.issn.1001-5256.2018.05.018

血清AFP对慢性乙型肝炎肝纤维化程度的预测价值

DOI: 10.3969/j.issn.1001-5256.2018.05.018

安徽医科大学第二附属医院检验科

基金项目:

国家自然科学基金面上项目(81171662)；安徽省教育厅省级教学质量工程项目(2016jxtd059)；

详细信息

中图分类号: R512.62
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出版历程
- 收稿日期: 2017-11-28
- 出版日期: 2018-05-20

Value of serum alpha-fetoprotein in predicting liver fibrosis in patients with chronic hepatitis B

Department of Clinical Laboratory, The Second Affiliated Hospital of Anhui Medical University

Research funding:

摘要

摘要: 目的探讨血清AFP与乙型肝炎肝纤维化等级的关系,评估血清AFP对乙型肝炎肝纤维化的预测价值。方法收集2015年5月-2017年5月安徽医科大学第二附属医院已确诊的慢性乙型肝炎（CHB）住院患者286例,另选取2016年3月-2017年6月本院门诊体检中心体检合格健康成人150例作为健康对照组。CHB患者行肝穿刺活组织检查,血液学指标检测PLT、ALT、AST、TBil、Alb、Glo、ALP、GGT、AFP、HBV DNA、HBs Ag等。符合正态分布的计量资料2组间比较采用独立样本t检验,非正态分布的计量资料组间比较采用Mann-Whitney U检验;AFP与临床指标的相关性分析采用Spearman秩和分析;血清AFP水平预测肝纤维化的敏感性和特异性分析采用受试者工作特征曲线（ROC曲线）评估。结果 286例CHB患者中肝纤维化分级S0 19例、S1 156例、S2 52例、S3 39例、S4 20例,经Spearman相关性分析发现血清AFP水平与肝纤维化分级呈正相关（r=0.373,P<0.000 1）;CHB患者血清AFP水平为2.89（1.875...
- 肝炎,乙型,慢性 /
- 肝硬化 /
- 甲胎蛋白类
Abstract: Objective To investigate the correlation between serum alpha-fetoprotein ( AFP) and classification of liver fibrosis in patients with chronic hepatitis B ( CHB) , as well as the value of serum AFP in predicting liver fibrosis in CHB patients. Methods A total of 286 patients with a confirmed diagnosis of CHB who were hospitalized in our hospital from May 2015 to May 2017 were enrolled, and 150 healthy adults who underwent physical examination at the Physical Examination Center in our hospital from March 2016 to June 2017 and had qualified results were enrolled as healthy control group. Liver biopsy was performed for CHB patients, and related hematological parameters were measured, including platelet count ( PLT) , alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , total bilirubin ( TBil) , albumin ( Alb) , globulin ( GLB) , alkaline phosphatase ( ALP) , gamma-glutamyl transpeptidase ( γ-GGT) , AFP, HBV DNA, and hepatitis B surface antigen ( HBs Ag) . The independent samples t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; a Spearman correlation analysis was used to investigate the correlation between AFP and clinical indices; the receiver operating characteristic ( ROC) curve was used to evaluate the sensitivity and specificity of serum AFP level in predicting liver fibrosis. Results Of all 286 CHB patients, 19 had S0 liver fibrosis, 156 had S1 liver fibrosis, 52 had S2 liver fibrosis, 39 had S3 liver fibrosis, and 20 had S4 liver fibrosis; the Spearman correlation analysis showed that serum AFP level was positively correlated with the classification of liver fibrosis ( r = 0. 373, P < 0. 000 1) . There was a significant difference in serum AFP level between the CHB group and the healthy control group [2. 89 ( 1. 87-5. 59) ng/ml vs 2. 11 ( 1. 21-3. 10) ng/ml, P = 0. 0027]. There was also a significant difference in serum AFP level between the CHB patients with insignificant liver fibrosis and those with significant liver fibrosis [2. 51 ( 1. 70-3. 81) ng/ml vs 4. 17 ( 2. 42-14. 06) ng/ml, P = 0. 0069]. In CHB patients, serum AFP level was positively correlated with ALT ( r = 0. 393, P < 0. 000 1) , AST ( r = 0. 419, P < 0. 000 1) , and HBV DNA ( r = 0. 231, P < 0. 05) . There was no significant correlation between AFP level and HBs Ag ( r = 0. 154, P > 0. 05) . The correlation analysis showed that serum AFP level was positively correlated with aspartate aminotransferase-to-platelet ratio index in CHB patients ( r =0. 342, P < 0. 000 1) . The ROC curve was used to investigate the value of serum AFP level in predicting liver fibrosis, and the results showed that at the cut-off value of 3. 8 ng/ml, serum AFP level had a specificity of 84. 92%, a sensitivity of 37. 41%, and an area under the ROC curve of 0. 674 ( P < 0. 0001) , with a 95% confidence interval of 2. 03-8. 00 ng/ml. Conclusion In CHB patients, serum AFP level increases with the increase in liver fibrosis grade, and therefore, it has a good clinical value in evaluating significant liver fibrosis.
- hepatitis B, chronic /
- liver cirrhosis /
- alpha-fetoproteins

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参考文献(16)

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