Assessment of serum Golgi protein 73 as a biomarker for the diagnosis of significant fibrosis in patients with chronic HBV infection
Assessment of serum Golgi protein 73 as a biomarker for the diagnosis of significant fibrosis in patients with chronic HBV infection
复制标题
评估血清高尔基体蛋白 73 作为诊断慢性 HBV 感染患者显着纤维化的生物标志物。
DOI：
10.1111/jvh.12786
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发表时间：
2017-11-01
影响因子：
2.5
通讯作者：
Xie, Q.
中科院分区：
文献类型：
--
作者：
Cao, Z.;Li, Z.;Xie, Q.
瞬时弹性成像（TE）在无创纤维化分期中是准确的。然而，具有相当准确性的可靠的血清生物标志物也很重要，特别是当TE不可靠/不可用时。因此，我们旨在评估血清高尔基蛋白73 （GP73）对慢性HBV感染患者显著纤维化的诊断作用。共有801例慢性肝病（CLD； 492例慢性HBV感染和309例非HBV肝病）患者入组肝活检。纳入健康对照（n=180）和肝细胞癌（HCC）患者（n=85）进行比较。肝活检作为肝纤维化分期的参考方法。采用双盲法分两组测定血清GP73水平。血清GP73在HCC中最高，但在慢性乙型肝炎中也显著高于健康对照组。非hcc患者血清GP73升高与显著纤维化存在显著相关，与ALT水平、肝硬度（LS）值、炎症分级等混杂因素无关。血清GP73对未接受抗病毒治疗的HBV患者诊断准确（受试者工作曲线下面积[AUROC]， 0.76 95% CI: 0.72-0.81），但对正在接受抗病毒治疗的患者诊断不准确（AUROC, 0.60）。血清GP73在非hbv CLD中的效用也得到证实（AUROC, 0.80 95% CI: 0.75-0.85）。血清GP73与LS相当（AUROC, 0.78 95% CI: 0.73-0.82），显著优于AST与血小板比值指数（APRI） （AUROC, 0.67 95% CI: 0.62-0.72）和FIB-4 （AUROC, 0.68 95% CI: 0.63-0.73）。综上所述，血清GP73是慢性HBV感染显著纤维化的准确血清标志物，其准确性高于APRI和FIB-4。在评估抗病毒治疗的必要性时，血清GP73可能是TE的补充工具，特别是在没有明确抗病毒适应症的患者中。
Transient elastography (TE) is accurate in staging fibrosis noninvasively. However, a reliable serum biomarker with comparable accuracy is also important, especially when TE is unreliable/unavailable. Therefore, we aimed to evaluate the diagnostic performance of serum Golgi protein 73 (GP73) for significant fibrosis in patients with chronic HBV infection. A total of 801 patients with chronic liver disease (CLD; 492 chronic HBV infection and 309 non-HBV liver disease) with liver biopsy performance were enrolled. Healthy controls (n=180) and hepatocellular carcinoma (HCC) patients (n=85) were included for comparisons. Liver biopsy was used as the reference method for fibrosis staging. Serum GP73 level was measured in duplicate in double-blind fashion. Serum GP73 was highest in HCC but also significantly higher in chronic hepatitis B than in healthy controls. The elevation of serum GP73 in non-HCC patients was significantly associated with the presence of significant fibrosis independently of ALT level, liver stiffness (LS) value, inflammation grade and other confounding factors. The diagnostic performance of serum GP73 was accurate in antiviral-naive HBV patients (area under the receiver operating curve [AUROC], 0.76 95% CI: 0.72-0.81) but not in patients with ongoing antiviral treatment (AUROC, 0.60). The utility of serum GP73 was also confirmed in non-HBV CLD (AUROC, 0.80 95% CI: 0.75-0.85). Serum GP73 was comparable to LS (AUROC, 0.78 95% CI: 0.73-0.82) and significantly better than AST to platelet ratio index (APRI) (AUROC, 0.67 95% CI: 0.62-0.72) and FIB-4 (AUROC, 0.68 95% CI: 0.63-0.73). In conclusion, serum GP73 is an accurate serum marker for significant fibrosis in chronic HBV infection, with higher accuracy than APRI and FIB-4. Serum GP73 is potentially a complementary tool for TE when evaluating the necessity of antiviral treatment, particularly in patients without definite antiviral indication.