超氧化物歧化酶检测在乙型肝炎病毒相关性肝病中的应用价值

doi:10.3877/cma.j.issn.2095-5820.2023.01.005

目的

评估超氧化物歧化酶（SOD）检测在HBV相关性肝病中的临床应用价值，为HBV相关性肝病的诊疗提供参考。

方法

收集HBV相关性肝病患者300例和健康体检者110例，检测血清中SOD活性、甲胎蛋白（AFP）、总胆红素（TBIL）、总蛋白（TP）、白蛋白（ALB）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、谷氨酰转肽酶（GGT）及HBV-DNA，分析比较各指标的组间差异，同时分析SOD与各指标间的相关性，采用受试者工作特征（ROC）曲线分析SOD对HBV相关性慢性肝炎（CHB）、肝硬化（HBV-LC）和肝癌（HBV-HCC)的诊断效能。

结果

HBV相关性肝病患者血清AFP、AST、ALT、GGT、TBIL水平均较健康对照组高，且AFP、GGT、TBIL随着疾病的进展逐渐升高；而HBV相关性肝病患者血清SOD、TP、ALB水平均较健康对照组降低，其中TP、ALB随着疾病的进展而降低。SOD活性比较发现，与健康对照组相比，HBV-LC患者和HBV-HCC患者血清SOD水平显著降低（P＜0.05）；与CHB患者相比，HBV-LC患者和HBV-HCC患者血清SOD水平显著降低（P＜0.05）。相关分析显示HBV-LC患者SOD活性与TP、ALB呈正相关（均P＜0.05），与AFP、AST、TBIL呈负相关（均P＜0.05）；HBV-HCC患者SOD活性与TP、ALB呈正相关（均P＜0.05），与AFP、AST、GGT、TBIL、HBV-DNA呈负相关（均P＜0.05）。SOD对HBV相关性肝病诊断效能分析，HBV-LC患者和HBV-HCC患者血清SOD曲线下面积具有统计学意义。

结论

SOD活性降低可反映HBV相关性肝病患者的肝脏损害，用于HBV相关性肝病患者疾病进展的监测，为鉴别慢性肝炎是否向肝硬化、肝癌发展提供依据，联合其它实验室检查可辅助诊断HBV相关性肝硬化、肝癌。

关键词: 超氧化物歧化酶, 乙型肝炎病毒, 慢性乙型肝炎, 肝硬化, 肝细胞癌

Objective

To estimate application value of superoxide dismutase (SOD) test in hepatitis B virus (HBV) related liver disease, and to provide reference for the diagnosis and treatment of HBV related liver disease.

Methods

A total of 300 patients with HBV related liver disease and 110 healthy controls were enrolled in our study. The serum enzyme activity of SOD, alpha-fetoprotein (AFP), total bilirubin (TBIL), total protein (TP), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT) and HBV-DNA were detected. The difference of tested indexes in difference groups, and the correlations between SOD and the other biomarkers were analyzed. The receiver operating characteristic (ROC) curve were applied to analyze the diagnosis efficacy of SOD in chronic hepatitis B (CHB), hepatitis B virus related liver cirrhosis (HBV-LC), and hepatocellular carcinoma (HBV-HCC).

Results

In patients with HBV related liver disease, the levels of AFP, AST, ALT, GGT, TBIL were significantly higher than those in healthy people, and AFP, GGT and TBIL increased gradually with the progression of the disease. However, the levels of SOD, TP and ALB were decreased in patients with HBV related liver disease, the levels of TP and ALB were decreased with the progression of the disease. The SOD activity in HBV-LC and HBV-HCC patients were significantly lower than that in healthy group (P＜0.05), the level of SOD in HBV-LC and HBV-HCC patients was markedly lower than that in CHB patients (P＜0.05). Correlation analysis showed that the serum enzyme activity of SOD in HBV-LC patients was positively correlated with the value of TP, ALB (P＜0.05), and negatively correlated with AFP, AST, TBIL(P＜0.05). SOD activity in HBV-HCC patients was positively correlated with TP, ALB (P＜0.05), and negatively correlated with AFP, AST, GGT, TBIL, HBV-DNA (P＜0.05). Analysis of the efficacy of SOD in the diagnosis of HBV related liver diseases showed that the SOD area under the curve of HBV-LC patients and HBV-HCC patients had statistical significance (P＜0.05).

Conclusions

The decrease of SOD activity can reflect the liver damage of patients with HBV related liver disease, which can be used to monitor the development of the disease in patients with HBV related liver disease, and provide a basis for identifying whether there was transformation from chronic hepatitis B to LC or HCC. Combined with other laboratory examination, it can assist in the diagnosis of HBV-LC and HBV-HCC.

Key words: SOD, hepatitis B virus, chronic hepatitis B, liver cirrhosis, hepatocellular carcinoma

表1 HBV相关性肝病患者与健康对照组临床资料比较（

x ˉ

±s）

项目	健康对照组	CHB组	HBV-LC组	HBV-HCC组	P值
总例数/例	110	116	111	73	-
SOD/（U/ml）， $x ¯$ ±s	259.45±24.90	243.73±48.36	156.10±54.63	156.90±51.16	＜0.001
AFP/（ng/ml）， $x ¯$ ±s	3.43±1.24	5.31±7.87	10.22±13.29	4709.10±12 688.04	＜0.001
AST/（IU/L）， $x ¯$ ±s	22.13±5.47	72.26±157.06	52.68±46.27	100.37±101.07	＜0.001
ALT/（IU/L）， $x ¯$ ±s	22.26±10.84	116.76±292.09	41.74±32.00	85.08±149.29	＜0.001
GGT/（U/L）， $x ¯$ ±s	21.73±9.80	59.68±108.97	102.85±253.02	164.52±208.82	＜0.001
TP/（g/L）， $x ¯$ ±s	74.20±4.36	71.92±5.82	67.87±8.35	66.25±7.18	＜0.001
ALB/（g/L）， $x ¯$ ±s	44.95±2.98	42.08±5.29	35.62±7.53	34.40±7.65	＜0.001
TBIL/（μmol/L）， $x ¯$ ±s	16.45±4.64	28.48±41.54	41.64±45.67	58.52±123.75	＜0.001
HBV-DNA，log10/（IU/ml）， $x ¯$ ±s	-	1.37±2.02	0.57±1.44	1.93±2.49	＜0.001

表1 HBV相关性肝病患者与健康对照组临床资料比较（

x ˉ

±s）

项目	健康对照组	CHB组	HBV-LC组	HBV-HCC组	P值
总例数/例	110	116	111	73	-
SOD/（U/ml）， $x ¯$ ±s	259.45±24.90	243.73±48.36	156.10±54.63	156.90±51.16	＜0.001
AFP/（ng/ml）， $x ¯$ ±s	3.43±1.24	5.31±7.87	10.22±13.29	4709.10±12 688.04	＜0.001
AST/（IU/L）， $x ¯$ ±s	22.13±5.47	72.26±157.06	52.68±46.27	100.37±101.07	＜0.001
ALT/（IU/L）， $x ¯$ ±s	22.26±10.84	116.76±292.09	41.74±32.00	85.08±149.29	＜0.001
GGT/（U/L）， $x ¯$ ±s	21.73±9.80	59.68±108.97	102.85±253.02	164.52±208.82	＜0.001
TP/（g/L）， $x ¯$ ±s	74.20±4.36	71.92±5.82	67.87±8.35	66.25±7.18	＜0.001
ALB/（g/L）， $x ¯$ ±s	44.95±2.98	42.08±5.29	35.62±7.53	34.40±7.65	＜0.001
TBIL/（μmol/L）， $x ¯$ ±s	16.45±4.64	28.48±41.54	41.64±45.67	58.52±123.75	＜0.001
HBV-DNA，log10/（IU/ml）， $x ¯$ ±s	-	1.37±2.02	0.57±1.44	1.93±2.49	＜0.001

图1 HBV相关性肝病患者与健康对照组血清SOD活性比较注：图中o为试验异常值，213和161为异常值具体数值。

表2 病例组SOD活性与其它血清学指标的相关性分析

项目	CHB组		HBV-LC组		HBV-HCC组
项目	R值	P值	R值	P值	R值	P值
AFP	0.004	0.969	-0.187	0.049	-0.517	＜0.001
AST	0.018	0.848	-0.327	＜0.001	-0.367	0.001
ALT	0.096	0.305	0.013	0.895	-0.162	0.171
GGT	-0.066	0.482	0.020	0.834	-0.386	0.001
TP	0.022	0.815	0.522	＜0.001	0.404	＜0.001
ALB	0.037	0.694	0.688	＜0.001	0.727	＜0.001
TBIL	0.106	0.256	-0.388	＜0.001	-0.317	0.006
HBV-DNA	0.311	0.001	-0.173	0.069	-0.360	0.002

表2 病例组SOD活性与其它血清学指标的相关性分析

项目	CHB组		HBV-LC组		HBV-HCC组
项目	R值	P值	R值	P值	R值	P值
AFP	0.004	0.969	-0.187	0.049	-0.517	＜0.001
AST	0.018	0.848	-0.327	＜0.001	-0.367	0.001
ALT	0.096	0.305	0.013	0.895	-0.162	0.171
GGT	-0.066	0.482	0.020	0.834	-0.386	0.001
TP	0.022	0.815	0.522	＜0.001	0.404	＜0.001
ALB	0.037	0.694	0.688	＜0.001	0.727	＜0.001
TBIL	0.106	0.256	-0.388	＜0.001	-0.317	0.006
HBV-DNA	0.311	0.001	-0.173	0.069	-0.360	0.002

图2 SOD活性对HBV相关性肝病的诊断价值注：2A. CHB组SOD的ROC曲线；2B. HBV-LC组SOD的ROC曲线；2C. HBV-HCC组SOD的ROC曲线。

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Application value of superoxide dismutase test in hepatitis B virus related liver disease

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Application value of superoxide dismutase test in hepatitis B virus related liver disease