传染病信息

目的 探究慢性乙型肝炎（chronic hepatitis B, CHB）患者超声弹性成像、血清基质金属蛋白酶-2(matrix metalloproteinase-2, MMP-2)、壳多糖酶3样蛋白1(chitinase 3-like protein 1, CHI3L1)在肝纤维化诊断中的效能。方法 回顾性分析2021年1月至2024年1月期间于沧州市人民医院就诊的185例CHB患者临床资料，基于肝组织穿刺活检的结果，对肝纤维化程度进行分期，将CHB患者划分为非显著性肝纤维化组（n=76）和显著性肝纤维化组（n=109）。采用酶联免疫吸附法测定血清MMP-2、CHI3L1表达水平；Logistic分析影响CHB患者肝纤维化的因素；受试者工作特征曲线分析超声弹性成像、MMP-2、CHI3L1对CHB患者肝纤维化的诊断价值。结果 非显著性肝纤维化组与显著性肝纤维化组丙氨酸氨基转移酶（alanine aminotransferase, ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase, AST）、白蛋白（albumin, ALB）水平、血小板计数（platelet, PLT）差异有统计学意义（均P<0.05）。与非显著性肝纤维化组相比，显著性肝纤维化组杨氏模量值、肝纤维化指数（liver fibrosis index, LF Index）、血清MMP-2、CHI3L1水平显著升高（均P<0.05）。MMP-2、CHI3L1、ALT、AST是影响CHB患者肝纤维化的危险因素（均P<0.05）,ALB、PLT是影响CHB患者肝纤维化的保护因素（均P<0.05）。血清MMP-2、CHI3L1、杨氏模量值、LF Index 4者联合诊断肝纤维化显示出最大的曲线下面积（area under the curve, AUC），优于各自单独诊断。诊断模型在外部验证中的AUC为0.981，敏感度为92.98%，特异度为95.35%。结论 超声弹性成像结合血清MMP-2、CHI3L1在CHB患者肝纤维化的诊断中展现出了良好的效能。

Objective To explore the efficacy of ultrasonic elastography combined with serum matrix metalloproteinase-2(MMP-2) and chitinase-3-like protein 1(CHI3L1) in the diagnosis of liver fibrosis in patients with chronic hepatitis B(CHB). Methods A retrospective analysis was conducted on the clinical data of 185 CHB patients who were admitted to Cangzhou People's Hospital from January 2021 to January 2024. Based on the results of liver biopsy, the degree of liver fibrosis was staged, and the CHB patients were divided into the non-significant liver fibrosis group(n=76) and the significant liver fibrosis group(n=109). The expression levels of MMP-2 and CHI3L1 in serum were determined by enzymelinked immunosorbent assay. Logistic analysis was applied to explore the factors affecting liver fibrosis in CHB patients. Receiver operating characteristic curve analysis of ultrasonic elastography, MMP-2 and CHI3L1 in the diagnosis of liver fibrosis in patients with CHB. Results Significant differences were observed between the non-significant liver fibrosis group and the significant liver fibrosis group in alanine aminotransferase(ALT), aspartate aminotransferase(AST), albumin(ALB), and platelet count(PLT)(P<0.05). Compared with the non-significant liver fibrosis group, the Young's modulus value, liver fibrosis index(LF Index), serum MMP-2, and CHI3L1 levels were obviously higher in the significant liver fibrosis group(P<0.05). MMP-2, CHI3L1, ALT, and AST were risk factors for liver fibrosis in CHB patients(P<0.05), while ALB and PLT were protective factors for liver fibrosis in CHB patients(P<0.05). The combination of serum MMP-2, CHI3L1, Young's modulus value, and LF Index had the highest AUC for diagnosing liver fibrosis in CHB patients, which was better than their individual diagnoses.The AUC of the diagnostic model in external validation was 0.981, with a sensitivity of 92.98% and a specificity of 95.35%. Conclusion ultrasonic elastography combined with serum MMP-2 and CHI3L1 has a good diagnostic efficacy for liver fibrosis in CHB patients.