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ALT小于2倍正常值上限的慢性乙型肝炎患者显著肝脏炎症的简易血清标志物探索
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
文章发布日期:2016年05月06日  来源:  作者:李强,黄玉仙,陈良  点击次数:1289次  下载次数:320次

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【摘要】: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(G0~1组);103例(37.1%)伴显著肝脏炎症(G2~4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、Glb、PT、HA、CG、PCⅢ和ⅣC的水平越高,伴显著肝脏炎症的可能性越大[比值比(OR)均>1,P值均<005];PLT、Alb和ANC的水平越低,伴显著肝脏炎症的可能性越大(OR均<1,P值均<005)。多因素回归分析发现GGT、PT、IVC和HA是ALT<2×ULN CHB患者显著肝脏炎症的独立预测因素(OR值分别为1.015、1.600、1.151、1.014,P值分别为0008、0.021、0.003、0018)。GGT、PT、IVC和HA诊断显著肝脏炎症的ROC曲线下面积依次为0.804、0.722、0.707和0.632。GGT≥48.5 U/L预测显著肝脏炎症的特异性为90.3%、阴性预测值为74.6%。结论GGT、PT、IVC和HA是ALT正常或2倍以内升高CHB患者显著肝脏炎症的独立预测因素,其中以GGT的预测价值最大。
【Abstract】:Abstract:ObjectiveTo 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). MethodsThe 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. ResultsOf the 278 CHB patients enrolled, 175 (62.9%) had no significant liver inflammation (G0-1 group) 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%. ConclusionGGT, 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.
【关键字】:肝炎,乙型,慢性;丙氨酸转氨酶;γ-谷氨酰转移酶;炎症
【Key words】:hepatitis B, chronic; alanine aminotransferase; γ-glutamyltranspeptidase; inflammation
【引证本文】:李强, 黄玉仙, 陈良. ALT小于2倍正常值上限的慢性乙型肝炎患者显著肝脏炎症的简易血清标志物探索[J]. 临床肝胆病杂志, 2016, 32(6): 1125-1129.

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