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

摘要：

目的 探讨血清细胞角蛋白 18 片段 M 30（CK18M30）及片段 M65（CK18M65）、血脂、受控衰减参数（controlled attenuation parameter，CAP）在慢性乙肝（chronic hepatitis B，CHB）合并代谢相关脂肪性肝病（metabolic-dysfunction-associated fatty liver disease，MAFLD）的诊断效能。方法 选取 CHB 合并MAFLD 患者 105 例。ELISA 检测各组患者血清 CK18M30、CK18M65，瞬时弹性成像技术（Fibroscan）检测CAP，腹部超声了解肝脏脂肪变性情况。通过 logistic 回归分析，采用受试者工作特征曲线下面积（AUC）评估联合血清 CK-18、血脂及 CAP 对 CHB 合并 MAFLD 的诊断效能。结果 MAFLD 组 、CHB 组和 CHB合并 MAFLD 组在丙氨酸转氨酶（alanine aminotransferase，ALT）、天冬氨酸转氨酶（aspartate transaminase，AST）、 碱 性 磷 酸 酶（alkaline phosphatase，ALP）、γ- 谷 氨 酰 转 肽 酶（Gamma-glutamyl transpeptidase，GGT）、空腹血糖（fasting blood-glucose，FBG）、高密度脂蛋白（high-density lipoprotein，HDL）、CK18M30比较无明显差异（P ＞ 0.05）；在 CAP、TC、LDL 及 BMI 比较在 MAFLD 组、CHB 合并 MAFLD 组明显高于 CHB 组（P ＜ 0.05）；CK18M65 在 CHB 合 并 MAFLD 高 于 MAFLD、CHB 组（P ＜ 0.05）；CK18M30、CK18M65、CAP、CAP-CK18M65、CAP-CK18M65-TC 和 CAP-CK18M65-LDL 诊 断 CHB 合 并 MAFLD 的AUC 分别为 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）和 0.837（0.728 ~ 0.915）。CAP、CK18 M65 及 LDL-C 的联合指标回归模型诊断 CHB 合并MAFLD 的最高为 0.837，敏感度和特异度分别为 0.811 和 0.719。结论 联合 CAP、CK18M65 及 LDL 3 项指标的回归模型对 CHB 合并 MAFLD 有更高的诊断价值。

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