关键词: 慢性乙肝 , 代谢相关性脂肪性肝病 , 细胞角蛋白 18 , 受控衰减参数 , 血脂 , 诊断

Abstract:

Objective To investigate the diagnostic value of cytokeratin 18 M30（CK18M30）and M65（CK18M65）, blood lipids and controlled attenuation parameter（CAP）in chronic hepatitis B（CHB）with metabolic-dysfunction-associated fatty liver disease（MAFLD）. Methods A total of 105 CHB patients concomitant with MAFLD patients were included from April 2019 to April 2020 were. Serum CK18M30, CK18M65 levels were measured by enzyme linked immunosorbent assay（ELISA）; CAP was measured by Fibroscan; and ultrasonography was used to assessed the extent of hepatic steatosis. The index of serum CK18, blood lipids and CAP was analyzed by binary logistic regression, and the diagnostic value of the above indexes for CHB with MAFLD was evaluated by the areas under the receiver operating characteristic curve（AUC）. Results ALT, AST, ALP, GGT, FBG, HDL, CK18M30 levels between MAFLD, CHB and CHB with MAFLD groups showed no significant statistical difference（P ＞ 0.05）. Compared to CHB group, the levels of CAP, TC, LDL and BMI were significantly higher in MAFLD and CHB with MAFLD groups（P ＜ 0.05）. CK18M65 level in CHB with MAFLD group was significantly higher than in MAFLD and CHB groups（P ＜ 0.05）. The AUC of CK18M30, CK18M65, CAP, CAP-CK18M65, CAP-CK18M65-TC and CAP-CK18M65-LDL for the diagnosis of CHB with MAFLD were 0.572（0.455 ~ 0.683）, 0.651（0.535 ~ 0.755）, 0.737（0.626 ~ 0.830）, 0.774（0.666 ~ 0.860）, 0.797（0.691 ~ 0.879）and 0.837（0.728 ~ 0.915）, respectively. Among the parameters, the combination of CAP, CK18M65 and LDL had the largest AUC and the corresponding sensitivity and specificity were 0.811 and 0.719, respectively. Conclusion The combination of CAP, CK18M65 and LDL has a superior diagnostic diagnastic value for CHB with MAFLD. 

Key words: Chronic hepatitis B； Metabolic-dysfunction-associated fatty liver disease； Cytokeratin 18； Controlled attenuation parameter； Blood lipids, Diagnosis