摘要
目的:探究慢性丙型肝炎(CHC)患者血清五聚蛋白3(PTX3)的表达水平,并分析PTX3对肝纤维化分期诊断的临床意义。方法:选取2016年9月至2019年10月济宁医学院附属医院消化内科收治的178例CHC患者为CHC组,男92例,女86例,年龄(42.28±13.70)岁,年龄范围为24~67岁。另选取同时期体检的30例健康者作为健康组,男19例,女11例,年龄(43.05±12.88)岁,年龄范围为22~66岁。应用酶联免疫吸附法(ELISA)检测血清白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、透明质酸、层黏连蛋白(LN)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原蛋白(CⅣ)及PTX3的水平。结果:CHC组血清IL-2水平[(97.27±26.39)pg/ml]显著低于健康组[(146.4±31.02)pg/ml],IL-6[(72.65±10.26)pg/ml]、TNF-α水平[(32.58±6.75)pg/ml]均显著高于健康组[(36.61±11.05)pg/ml、(11.13±2.34)pg/ml],差异有统计学意义(P<0.05);CHC患者的血清透明质酸[(255.22±69.98)μg/L]、LN[(173.36±33.02)μg/L]、PⅢP[(163.23±40.89)μg/L]、CⅣ[(227.20±72.77)μg/L]、PTX3水平[(4.47±1.20)μg/L]均显著高于健康组[(74.97±15.73)μg/L、(78.36±12.82)μg/L、(71.95±6.10)μg/L、(44.86±2.64)μg/L、(0.37±0.11)μg/L],差异有统计学意义(P<0.05);经Pearson相关性分析,血`清PTX3水平与IL-2呈显著负相关,而与IL-6、TNF-α、透明质酸、LN、PⅢP、CⅣ等均呈显著正相关(P<0.05);CHC组不同肝纤维化程度患者血清PTX3水平上差异显著(P<0.05),且CHC患者病理学结果显示,F1期为39例、F2期为61例、F3期为33例、F4期为45例。4组CHC患者在PTX3水平上比较,F4期>F3期>F2期>F1期,差异有统计学意义(P<0.05);诊断价值采用ROC曲线结果显示F1期的诊断以PTX3取2.070μg/L诊断效果最佳,AUC为0.628,特异度为0.921,灵敏度为0.402;F2期的诊断以PTX3取2.430μg/L诊断效果最佳,AUC为0.661,特异度为0.770,灵敏度为0.615;F3期的诊断以PTX3取3.245μg/L诊断效果最佳,AUC为0.789,特异度为0.727,灵敏度为0.872;F4期的诊断以PTX3取4.530μg/L诊断效果最佳,AUC为0.842,特异度为0.844,灵敏度为0.923。结论:血清PTX3水平在CHC患者中显著升高,且与CHC患者肝纤维化程度密切相关,可作为辅助诊断CHC肝纤维化程度的新指标。
Objective To investigate the expression level of serum pentraxin 3(PTX3)in patients with chronic hepatitis C(CHC),and to analyze the clinical significance of PTX3 in the staging diagnosis of liver fibrosis.Methods From September 2016 to October 2019,178 patients with CHC were enrolled in the Department of Gastroenterology,Affiliated Hospital of Jining Medical College,including 92 males and 86 females,aged(42.28±13.70)years old and ranging in age from 24 to 67 years old.Another 30 healthy persons in the same period were selected as the healthy group,including 19 males and 11 females,aged(43.05±12.88)years old and ranging in age from 22 to 66 years old.The serum levels of interleukin-2(IL-2),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hyaluronic acid,laminin(LN),procollagen typeⅢpeptide(PⅢP),collagen typeⅣ(CⅣ)and PTX3 were detected by enzyme-linked immunosorbent assay(ELISA).Results Serum levels of IL-2[(97.27±26.39)pg/ml]in the CHC group were significantly lower than those in the healthy group[(146.4±31.02)pg/ml],levels of IL-6[(72.65±10.26)pg/ml]and TNF-α[(32.58±6.75)pg/ml]were significantly higher than those in the healthy group[(36.61±11.05)pg/ml and(11.13±2.34)pg/ml],with statistically significant differences(P<0.05).CHC patients serum hyaluronic acid[(255.22±69.98)μg/L],LN[(173.36±33.02)μg/L],PⅢP[(163.23±40.89)μg/L],CⅣ[(227.20±72.77)μg/L],PTX3 level[(4.47±1.20)μg/L]were significantly higher than that of healthy group[(74.97±15.73)μg/L,(78.36±12.82)μg/L,(71.95±6.10)μg/L,(44.86±2.64)μg/L,(0.37±0.11)μg/L],(P<0.05).The Pearson correlation analysis showed that serum levels of PTX3 had negative correlation with IL-2,and had positive correlation with IL-6,TNF-α,hyaluronic acid,LN,PⅢP and CⅣ(P<0.05).The serum PTX3 level of patients with different degrees of liver fibrosis in the CHC group was significantly different(P<0.05),and the pathological results of CHC patients showed that 39 patients were in stage F1,61 were in stage F2,33 were in stage F3 and 45 were in stage F4.The four groups of CHC patients were compared on the level of PTX3,and the difference was statistically significant in stage F4>F3>F2>F1,(P<0.05).ROC curve results showed that PTX3 was used to set 2.070μg/L,the AUC was 0.628,the specificity was 0.921,and the sensitivity was 0.402.In the diagnosis of F2 stage,the best diagnostic effect was set by PTX3 as 2.430μg/L,the AUC was 0.661,the specificity was 0.770,and the sensitivity was 0.615.In the diagnosis of F3 stage,the best diagnostic effect was set as 3.245μg/L by PTX3,the AUC was 0.789,the specificity was 0.727,and the sensitivity was 0.872.In the diagnosis of F4 stage,the best diagnostic effect was obtained by using PTX3 as 4.530μg/L,the AUC was 0.842,the specificity was 0.844,and the sensitivity was 0.923.Conclusion Serum PTX3 level was significantly increased in patients with CHC,and it was closely related to the degree of liver fibrosis in patients with CHC.It can be used as a new index to assist the diagnosis of liver fibrosis in patients with CHC.
作者
张茜茜
张帆
王登芹
万磊
随萍
赵士兴
Zhang Qianqian;Zhang Fan;Wang Dengqin;Wan Lei;Sui Ping;Zhao Shixing(Department of Diagnostics,Jining Medical University,Jining 272000,China;Department of Gastroenterology,Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Clinical Medical Skills Center,Jining Medical University,Jining 272000,China;Department of Neurobiology,Jining Medical University,Jining 272000,China;Department of Intensive Care Unit,Affiliated Hospital of Jining Medical University,Jining 272000,China)
出处
《中国临床实用医学》
2020年第2期1-6,共6页
China Clinical Practical Medicine
基金
山东省自然科学基金(ZR2017BH056)
山东省自然科学基金(ZR2017PC019)。
