血清壳多糖酶3样蛋白1和甲胎蛋白联合检测对不同肝脏疾病的诊断价值
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摘要
目的评估血清壳多糖酶3样蛋白1(CHI3L1)和甲胎蛋白(AFP)联合检测对不同肝脏疾病的临床诊断价值。方法将147例乙肝病毒感染患者分为正常组(36例)、肝纤维化组(43例)、肝硬化组(38例)、肝癌组(30例),对四组患者分别采取AFP、CHI3L1单独与联合检测,评估不同检测方法对不同肝脏疾病的阳性率、ROC曲线下面积、敏感性与特异性。结果与正常组相比,肝纤维化组、肝硬化组、肝癌组的AFP、CHI3L1指标均升高,其中肝癌组AFP水平高于肝纤维化组与肝硬化组,CHI3L1水平随着疾病的加重而升高(P<0. 05); AFP+CHI3L1联合检测对不同肝脏疾病的阳性率高于AFP、CHI3L1单独检测的阳性率(P<0. 05);在肝纤维化组中,AFP+CHI3L1联合检测的AUC值优于AFP(P<0. 05),但与CHI3L1检测差异无统计学意义(P> 0. 05);在肝硬化组和肝癌组,AFP+CHI3L1联合检测的AUC值优于CHI3L1(P<0. 05),但与AFP检测差异无统计学意义(P> 0. 05)。结论 AFP与CHI3L1联合检测对不同肝脏疾病的诊断效能要略优于AFP单项检测,而CHI3L1在鉴别不同肝脏疾病的临床诊断价值方面有待于进一步的研究。
Objective To evaluate the clinical diagnostic value of combined detection of serum chitinase-like protein1( CHI3 L1) and alpha-fetoprotein( AFP) for different liver diseases.Methods We divided 147 patients with hepatitis B virus infection into healthy group( n = 36),liver fibrosis group( n = 43),liver cirrhosis group( n = 38) and liver cancer group( n = 30). AFP and CHI3 L1 were measured alone and jointly for the four groups.The positive rate of different test methods for different liver diseases,the area under the ROC curve,and sensitivity and specificity were evaluated.Results Compared with the healthy group,AFP and CHI3 L1 in the liver fibrosis group,the liver cirrhosis group and the liver cancer group were all increased.The AFP level of the liver cancer group was higher than that of the liver fibrosis group and the cirrhosis group,and CHI3 L1 level was increased as the disease worsens( P <0. 05).The positive rate of the combined detection for different liver diseases was higher than that of AFP or CHI3 L1 alone( P<0. 05).In the hepatic fibrosis group,the combined detection was significantly better than AFP alone( P< 0. 05),but there was no significant difference when compared with CHI3 L1 detection alone( P > 0. 05).In the cirrhosis group and liver cancer group,the combined detection was significantly better than CHI3 L1 alone( P < 0. 05),but there was no significantly different from AFP detection alone( P >0. 05).Conclusion The combined detection of AFP and CHI3 L1 is better than AFP single test for the diagnosis of different liver diseases,and CHI3 L1 needs further researches to prove its clinical diagnostic value for different liver diseases.
Objective To evaluate the clinical diagnostic value of combined detection of serum chitinase-like protein1( CHI3 L1) and alpha-fetoprotein( AFP) for different liver diseases.Methods We divided 147 patients with hepatitis B virus infection into healthy group( n = 36),liver fibrosis group( n = 43),liver cirrhosis group( n = 38) and liver cancer group( n = 30). AFP and CHI3 L1 were measured alone and jointly for the four groups.The positive rate of different test methods for different liver diseases,the area under the ROC curve,and sensitivity and specificity were evaluated.Results Compared with the healthy group,AFP and CHI3 L1 in the liver fibrosis group,the liver cirrhosis group and the liver cancer group were all increased.The AFP level of the liver cancer group was higher than that of the liver fibrosis group and the cirrhosis group,and CHI3 L1 level was increased as the disease worsens( P <0. 05).The positive rate of the combined detection for different liver diseases was higher than that of AFP or CHI3 L1 alone( P<0. 05).In the hepatic fibrosis group,the combined detection was significantly better than AFP alone( P< 0. 05),but there was no significant difference when compared with CHI3 L1 detection alone( P > 0. 05).In the cirrhosis group and liver cancer group,the combined detection was significantly better than CHI3 L1 alone( P < 0. 05),but there was no significantly different from AFP detection alone( P >0. 05).Conclusion The combined detection of AFP and CHI3 L1 is better than AFP single test for the diagnosis of different liver diseases,and CHI3 L1 needs further researches to prove its clinical diagnostic value for different liver diseases.
引文
[1]石玉如，岳莉，赵长城．血清壳多糖酶3样蛋白1检测在不同肝脏疾病中的应用价值[J]．现代检验医学杂志，2017,32(6):39-42.
[2]李洪，严桐，朱珍，等．血清壳多糖酶3样蛋白1在慢性肝病显著纤维化和肝硬化中的诊断价值[J]．中华肝脏病杂志，2018,26(5):337-341.
[3]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(2015年版)[J]．实用肝脏病杂志，2016,19(3):5-16.
[4]中国中西医结合学会消化系统疾病专业委员会．肝纤维化中西医结合诊疗共识意见(2017年)[J]．中国中西医结合消化杂志，2017,25(12):895-900.
[5]中国临床肿瘤学会指南工作委员会．中国临床肿瘤学会(CSCO)原发性肝癌诊疗指南[M]．北京:人民卫生出版社，2018.
[6]刘昱含，谢青．肝纤维化的临床评估[J]．肝脏，2013,18(6):414-417.
[7]顾春瑜，石新慧，王海滨．肝硬化患者血清肝纤维化指标联合AFU和AFP检测的临床价值[J]．国际检验医学杂志，2013,34(15):1957-1958.
[8]聂荣慧，刘元元．肿瘤标志物AFP、CAl25、CAl99和CEA检测在肝炎、肝硬化患者诊断和治疗中的应用[J]．吉林大学学报(医学版)，2012,38(1):119-122.
[9]赵小云，尚守亮．血清3项肿瘤标志物联合检测在原发性肝癌诊断中的意义[J]．检验医学与临床，2013,10(24):3279-3280.
[10]徐丹，吴小宁，李红卫．肝病患者血清HA、PⅢNP、LN、Ⅳ与临床分型的关系[J]．实用预防医学，2010,17(12):2382-2385.
[11]李洪，严桐，朱珍，等．血清壳多糖酶3样蛋白1在慢性肝病显著纤维化和肝硬化中的诊断价值[J]．中华肝脏病杂志，2018,26(5):337-341.
[12]Xiao XQ,Hassanein T,Li QF,et al.YKL-40 expression in human hepatocellular carcinoma:a potential biomarker[J]. Hepatobiliary Pancreat Dis Int,2011,10(6):605-610.
[13]徐斌，蒋敬庭，吴昌平．AFP-Ig M复合物联合AFP对诊断肝癌的互补作用[J]．现代检验医学杂志，2010,25(1):71-73.
[2]李洪，严桐，朱珍，等．血清壳多糖酶3样蛋白1在慢性肝病显著纤维化和肝硬化中的诊断价值[J]．中华肝脏病杂志，2018,26(5):337-341.
[3]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(2015年版)[J]．实用肝脏病杂志，2016,19(3):5-16.
[4]中国中西医结合学会消化系统疾病专业委员会．肝纤维化中西医结合诊疗共识意见(2017年)[J]．中国中西医结合消化杂志，2017,25(12):895-900.
[5]中国临床肿瘤学会指南工作委员会．中国临床肿瘤学会(CSCO)原发性肝癌诊疗指南[M]．北京:人民卫生出版社，2018.
[6]刘昱含，谢青．肝纤维化的临床评估[J]．肝脏，2013,18(6):414-417.
[7]顾春瑜，石新慧，王海滨．肝硬化患者血清肝纤维化指标联合AFU和AFP检测的临床价值[J]．国际检验医学杂志，2013,34(15):1957-1958.
[8]聂荣慧，刘元元．肿瘤标志物AFP、CAl25、CAl99和CEA检测在肝炎、肝硬化患者诊断和治疗中的应用[J]．吉林大学学报(医学版)，2012,38(1):119-122.
[9]赵小云，尚守亮．血清3项肿瘤标志物联合检测在原发性肝癌诊断中的意义[J]．检验医学与临床，2013,10(24):3279-3280.
[10]徐丹，吴小宁，李红卫．肝病患者血清HA、PⅢNP、LN、Ⅳ与临床分型的关系[J]．实用预防医学，2010,17(12):2382-2385.
[11]李洪，严桐，朱珍，等．血清壳多糖酶3样蛋白1在慢性肝病显著纤维化和肝硬化中的诊断价值[J]．中华肝脏病杂志，2018,26(5):337-341.
[12]Xiao XQ,Hassanein T,Li QF,et al.YKL-40 expression in human hepatocellular carcinoma:a potential biomarker[J]. Hepatobiliary Pancreat Dis Int,2011,10(6):605-610.
[13]徐斌，蒋敬庭，吴昌平．AFP-Ig M复合物联合AFP对诊断肝癌的互补作用[J]．现代检验医学杂志，2010,25(1):71-73.
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