血清CHI3L1检测在原发性胆汁性胆管炎中的临床价值

The Clinical Value of Serum CHI3L1 Detection in Primary Biliary Cholangitis

摘要: 目的：探讨血清壳多糖酶3样蛋白1 (CHI3L1)检测在原发性胆汁性胆管炎(Primary Biliary Cholangitis, PBC)中的临床价值。方法：选取PBC患者153例作为病例组(PBC组)，其中非肝硬化患者106例(非肝硬化组)，肝硬化患者47例(肝硬化组)；健康体检者50例作为对照组。应用化学发光免疫法检测各受试者血清CHI3L1水平及血清IV型胶原(Col-IV)水平，同时检测血常规和肝功能并计算天门冬氨酸氨基转移酶与血小板比率(APRI)以及纤维化4指数(FIB-4)，比较各组间指标的水平差异，采用Spearman相关性作相关性分析，绘制受试者工作特征(ROC)曲线，计算曲线下面积(AUC)，评价各指标在PBC不同阶段的诊断价值。结果：PBC患者血清CHI3L1水平显著高于健康人群(P < 0.001)；肝硬化组与对照组间血清CHI3L1水平比较存在显著差异(P < 0.001)；肝硬化组与非肝硬化组间比较存在显著差异(P < 0.001)；非肝硬化组与对照组间比较存在显著差异(P = 0.022)；Spearman相关性分析显示，CHI3L1与Col-IV、APRI及FIB-4呈正相关，r_s值分别为0.376、0.470和0.540；ROC曲线显示，单指标鉴别PBC所致肝硬化时，血清CHI3L1的曲线下面积(AUC = 0.870)最大，联合检测进行诊断时，CHI3L1 + Col-IV + APRI的AUC最大(AUC = 0.929)，与血清CHI3L1单指标诊断比较差异有统计学意义(P = 0.033)。结论：血清CHI3L1水平在PBC患者中升高，肝硬化患者升高更明显，该指标可能是评估PBC进展为肝硬化的新标志物，联合检测对PBC所致肝硬化具有潜在的诊断价值。

Abstract: Objective: To investigate the clinical significance of serum chitosidase 3-like protein 1 (CHI3L1) in primary biliary cholangitis (PBC). Methods: A total of 143 patients with PBC were selected as the case group (PBC group), including 106 patients without liver cirrhosis (Non-Cirrhosis group) and 47 patients with liver cirrhosis (Cirrhosis group). A total of 50 healthy subjects were treated as the control group. The serum CHI3L1 level and serum Col-IV level of each subject were measured using chemiluminescence immunoassay. In addition, blood routine and liver function tests were conducted, and APRI and FIB-4 scores were calculated to assess variations in the levels of these parameters across the groups. The Spearman correlation coefficient was employed to analyze the correlations between different variables. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to evaluate the diagnostic value of each index in different stages of PBC. Results: The level of CHI3L1 in the PBC group was significantly higher than that in the control group (P < 0.001) and the non-Cirrhosis group (P < 0.001), and the non-Cirrhosis group was significantly higher than that in the control group (P = 0.022). The Spearman correlation analysis indicated a positive correlation between CHI3L1 and Col-IV, APRI, FIB-4 (r_s = 0.314, 0470, 0.540, respectively, P < 0.05). The ROC curve showed that the AUC (AUC = 0.870) of serum chi3l1 in the diagnosis of liver cirrhosis caused by PBC was the largest when a single index was used to identify liver cirrhosis; when combined detection was used for diagnosis, the AUC of CHI3L1 + COL-IV + APRI was the largest (AUC = 0.929), which was significantly different from the single index diagnosis of serum CHI3L1 (P = 0.033). Conclusion: Serum CHI3L1 levels were higher in PBC patients and more pronounced in those with liver cirrhosis, which could serve as a novel marker for tracking the progression of liver cirrhosis in PBC patients. Combined detection has potential diagnostic value for PBC induced cirrhosis.