论文部分内容阅读
目的:探讨反应性氧化物（ROS）、脂联素（ADPN）在慢性乙型肝炎病毒感染合并非酒精性脂肪性肝病（NAFLD）肝脏炎症判断中的应用价值。方法:收集2016年6月至2018年12月就诊且经肝组织病理学确诊的NAFLD（21例）、慢性乙型肝炎病毒感染（57例）、慢性乙型肝炎病毒感染合并NAFLD（81例）共159例患者资料，留取同期血清采用酶联免疫吸附法测定受试者血清ROS、ADPN水平，以肝组织病理检查为金标准，探讨其对慢性乙型肝炎病毒感染合并NAFLD患者发生非酒精性脂肪性肝炎的诊断价值。多组间比较采用单因素方差分析，组间两两比较采用LSD-n t检验。对非正态分布的计量资料用n M（P25，P75）表示，组间比较采用Mann-Whitney n U或Kruskal-Wallis n H检验。计数资料组间比较采用卡方检验。相关性分析采用Spearman相关分析。以肝组织病理分组为金标准，应用受试者工作特征曲线下面积评价回归公式的诊断效能。n 结果:(1)慢性乙型肝炎病毒感染合并NAFLD患者中，无肝脂肪变组及轻度肝脂肪变组ROS水平显著低于中、重度肝脂肪变组，而无肝脂肪变组的ADPN水平显著高于肝脂肪变组，n P值均< 0.05；(2)相关性分析结果显示ROS与NAS积分、肝脂肪变程度、小叶内炎症均显著相关，n P值均< 0.05；ADPN与肝脂肪变程度呈显著负相关，n P < 0.05。(3) Logistic回归分析结果显示慢性乙型肝炎病毒感染合并非酒精性脂肪性肝炎的诊断公式：0.02×受控衰减指数+ 0.584×白细胞/10 n 9 + 0.587×ROS - 10.982，受试者工作特征曲线下面积= 0.896，灵敏度97.1%，特异度71.2%，阳性预测值64.2%，阴性预测值97.9%。n 结论:ADPN、ROS对慢性乙型肝炎病毒感染合并NAFLD的肝脂肪变程度与炎症鉴别具有一定参考价值，慢性乙型肝炎病毒感染合并非酒精性脂肪性肝炎诊断公式则对非酒精性脂肪性肝炎的诊断及排除均具有较高的应用价值。“,”Objective:To investigate the application value of reactive oxygen species (ROS) and adiponectin (ADPN) in the judgment of liver inflammation in chronic hepatitis B virus infection combined with nonalcoholic fatty liver disease (NAFLD).Methods:A total of 159 cases with NAFLD (21 cases), chronic hepatitis B virus infection (57 cases), and chronic hepatitis B virus infection combined with NAFLD (81 cases) were collected between June 2016 to December 2018, and the visited patients diagnosis were confirmed by histopathological examination of the liver. ROS and ADPN level retained in serum was determined by enzyme-linked immunosorbent assay. Histopathological examination of liver tissue was used as the gold standard to discuss the diagnostic value of the serum in patients with chronic hepatitis B virus infection combined with NAFLD for the occurrence of nonalcoholic steatohepatitis. One-way analysis of variance was used for the comparison among multiple groups, and LSD-t test was used for pairwise comparison between groups. Measurement data for non-normal distributions were expressed as M (P25, P75). Comparisons between groups were performed using the Mann-Whitney U or Kruskal-Wallis H test. Chi-square test was used to compare the count data between groups. Correlation analysis was performed using Spearman correlation analysis. Histopathological grouping of liver tissue was used as the gold standard, and the area under the receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the regression formula.Results:(1) In patients with chronic hepatitis B virus infection combined with NAFLD, the levels of ROS in the non-hepatic steatosis group and the mild hepatic steatosis group were significantly lower than those in the moderate and severe hepatic steatosis group, while the ADPN level in the non-hepatic steatosis group was significantly higher than liver steatosis group, n P < 0.05. (2) The results of correlation analysis showed that ROS was significantly correlated with NAS score, change in the degree of fatty liver and lobular inflammation (all n P < 0.05).There was a significant negative correlation between ADPN and the change in the degree of fatty liver ( n P < 0.05). (3) Logistic regression analysis results showed that the diagnostic formula for chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis was 0.02 × controlled attenuation index + 0.584 × white blood cells/10 n 9 + 0.587 × ROS-10.982. The area under receiver operating characteristic curve of the subject was = 0.896. The sensitivity, specificity, positive and negative predictive value were 97.1%, 71.2%, 64.2%, and 97.9%.n Conclusion:ADPN and ROS have certain reference value in differentiating the change in the degree of fatty liver and inflammation in chronic hepatitis B virus infection combined with NAFLD and the diagnostic formula has higher application value in the diagnosis and exclusion of chronic hepatitis B virus infection combined with nonalcoholic steatohepatitis.