目的探讨慢性乙型肝炎肝纤维化患者血清和肽素(Copeptin)和降钙素原(procalcitonin,PCT)表达水平,并分析其在肝纤维化诊断中的价值。方法共纳入2019年2月~2021年12月在广西医科大学第四附属医院就诊的195例慢性肝病单感染HBV患者作为HBV...目的探讨慢性乙型肝炎肝纤维化患者血清和肽素(Copeptin)和降钙素原(procalcitonin,PCT)表达水平,并分析其在肝纤维化诊断中的价值。方法共纳入2019年2月~2021年12月在广西医科大学第四附属医院就诊的195例慢性肝病单感染HBV患者作为HBV组,并选择同一期间在该院进行健康体检的志愿者作为对照组。其中HBV组中慢性乙型肝炎(CHB)患者117例(CHB组),CHB相关肝硬化(LC)患者78例(LC组),对所有参与患者进行临床指标分析,采用ELISA方法检测患者血清Copeptin和PCT表达水平。METAVIR评分系统评估CHB组中接受肝活检的患者的肝纤维化程度;Child-Pugh分级评估LC患者的肝功能障碍程度。比较Copeptin,PCT表达水平与肝纤维化和肝功能的关系。ROC曲线评估肝纤维化诊断生物标志物。结果HBV组血清Copeptin(2.39±0.73 ng/ml vs 1.19±0.39ng/ml)和PCT(2.11±0.69 ng/ml vs 0.97±0.31 ng/ml)水平明显高于对照组(t=11.912,12.108,均P<0.05),并且与CHB组比较,LC组血清Copeptin(3.18±0.96 ng/ml vs 1.87±0.58 ng/ml)和PCT(2.87±0.92 ng/ml vs 1.61±0.53 ng/ml)表达水平增加(t=11.871,12.111,均P<0.05),差异具有统计学意义。血清Copeptin和PCT表达水平随着肝纤维化程度和Child-Pugh分级的增加而升高,差异有统计学意义(t=2.887~9.116,均P<0.05)。血清Copeptin和PCT表达水平及其他无创方法[肝脏硬度(LSM),AST与血小板比率指数(APRI)和纤维化-4(FIB-4)指数]区分CHB患者发生F0~F1期与F2~F3期肝纤维化的ROC曲线下面积分别为0.910,0.889,0.790,0.765和0.672,而以上五项指标联合的曲线下面积为0.962。Copeptin和PCT区分CHB患者肝纤维化程度的曲线下面积及总有效率高于肝纤维化指标(Ⅳ型胶原、Ⅲ型前胶原、透明质酸酶、层黏连蛋白)。结论血清Copeptin和PCT在慢性乙型肝炎肝纤维化患者中高表达,能够用于诊断肝纤维化程度。展开更多
BACKGROUND The relationship between copeptin and the severity of circulatory dysfunction and systemic stress response in patients with chronic liver disease(CLD)has been established.Nevertheless,the potential of serum...BACKGROUND The relationship between copeptin and the severity of circulatory dysfunction and systemic stress response in patients with chronic liver disease(CLD)has been established.Nevertheless,the potential of serum copeptin levels to predict the prognosis of CLD patients remains unclear.AIM To conduct a systematic review and meta-analysis to investigate the correlation between serum copeptin and transplant-free survival(TFS)in this population.METHODS To achieve the objective of the meta-analysis,PubMed,Embase,the Cochrane Library,and the Web of Science were searched to identify observational studies with longitudinal follow-up.The Cochrane Q test was utilized to assess betweenstudy heterogeneity,and the I2 statistic was estimated.Random-effects models were employed to combine the outcomes,taking into account the potential influence of heterogeneity.RESULTS Ten datasets including 3133 patients were involved.The follow-up durations were 1 to 48 mo(mean:12.5 mo).Overall,it was shown that a high level of serum copeptin was associated with a poor TFS[risk ratio(RR):1.82,95%confidence interval:1.52-2.19,P<0.001;I2=0%].In addition,sensitivity analysis by omitting one dataset at a time showed consistent results(RR:1.73-2.00,P<0.05).Finally,subgroup analyses according to study country,study design,patient diagnosis,cutoff of copeptin,follow-up duration,and study quality score also showed similar results(P for subgroup difference all>0.05).CONCLUSION Patients with CLD who have high serum copeptin concentrations may be associated with a poor clinical prognosis.展开更多
文摘目的探讨慢性乙型肝炎肝纤维化患者血清和肽素(Copeptin)和降钙素原(procalcitonin,PCT)表达水平,并分析其在肝纤维化诊断中的价值。方法共纳入2019年2月~2021年12月在广西医科大学第四附属医院就诊的195例慢性肝病单感染HBV患者作为HBV组,并选择同一期间在该院进行健康体检的志愿者作为对照组。其中HBV组中慢性乙型肝炎(CHB)患者117例(CHB组),CHB相关肝硬化(LC)患者78例(LC组),对所有参与患者进行临床指标分析,采用ELISA方法检测患者血清Copeptin和PCT表达水平。METAVIR评分系统评估CHB组中接受肝活检的患者的肝纤维化程度;Child-Pugh分级评估LC患者的肝功能障碍程度。比较Copeptin,PCT表达水平与肝纤维化和肝功能的关系。ROC曲线评估肝纤维化诊断生物标志物。结果HBV组血清Copeptin(2.39±0.73 ng/ml vs 1.19±0.39ng/ml)和PCT(2.11±0.69 ng/ml vs 0.97±0.31 ng/ml)水平明显高于对照组(t=11.912,12.108,均P<0.05),并且与CHB组比较,LC组血清Copeptin(3.18±0.96 ng/ml vs 1.87±0.58 ng/ml)和PCT(2.87±0.92 ng/ml vs 1.61±0.53 ng/ml)表达水平增加(t=11.871,12.111,均P<0.05),差异具有统计学意义。血清Copeptin和PCT表达水平随着肝纤维化程度和Child-Pugh分级的增加而升高,差异有统计学意义(t=2.887~9.116,均P<0.05)。血清Copeptin和PCT表达水平及其他无创方法[肝脏硬度(LSM),AST与血小板比率指数(APRI)和纤维化-4(FIB-4)指数]区分CHB患者发生F0~F1期与F2~F3期肝纤维化的ROC曲线下面积分别为0.910,0.889,0.790,0.765和0.672,而以上五项指标联合的曲线下面积为0.962。Copeptin和PCT区分CHB患者肝纤维化程度的曲线下面积及总有效率高于肝纤维化指标(Ⅳ型胶原、Ⅲ型前胶原、透明质酸酶、层黏连蛋白)。结论血清Copeptin和PCT在慢性乙型肝炎肝纤维化患者中高表达,能够用于诊断肝纤维化程度。
文摘BACKGROUND The relationship between copeptin and the severity of circulatory dysfunction and systemic stress response in patients with chronic liver disease(CLD)has been established.Nevertheless,the potential of serum copeptin levels to predict the prognosis of CLD patients remains unclear.AIM To conduct a systematic review and meta-analysis to investigate the correlation between serum copeptin and transplant-free survival(TFS)in this population.METHODS To achieve the objective of the meta-analysis,PubMed,Embase,the Cochrane Library,and the Web of Science were searched to identify observational studies with longitudinal follow-up.The Cochrane Q test was utilized to assess betweenstudy heterogeneity,and the I2 statistic was estimated.Random-effects models were employed to combine the outcomes,taking into account the potential influence of heterogeneity.RESULTS Ten datasets including 3133 patients were involved.The follow-up durations were 1 to 48 mo(mean:12.5 mo).Overall,it was shown that a high level of serum copeptin was associated with a poor TFS[risk ratio(RR):1.82,95%confidence interval:1.52-2.19,P<0.001;I2=0%].In addition,sensitivity analysis by omitting one dataset at a time showed consistent results(RR:1.73-2.00,P<0.05).Finally,subgroup analyses according to study country,study design,patient diagnosis,cutoff of copeptin,follow-up duration,and study quality score also showed similar results(P for subgroup difference all>0.05).CONCLUSION Patients with CLD who have high serum copeptin concentrations may be associated with a poor clinical prognosis.
