血清IP-10、Gas6和CHI3L1联合检测诊断慢性乙型肝炎患者肝纤维化的价值

doi:10.3969/j.issn.1673-8640.2026.01.003

摘要/Abstract

摘要：

目的探讨慢性乙型肝炎（CHB）患者血清γ-干扰素诱导蛋白10（IP-10）、生长停滞特异性基因产物6（Gas6）、壳多糖酶3样蛋白1（CHI3L1）水平及其临床意义。方法选取2022年5月—2024年5月南阳市中心医院CHB患者148例（CHB组）、健康体检者148名（正常对照组）。根据肝脏炎症程度将CHB患者分为轻度炎症（G1~G2期）组（69例）和重度炎症（G3~G4期）组（79例）。根据肝纤维化程度将CHB患者分为显著性肝纤维化（S2~S4期）组（80例）和非显著性肝纤维化（S1期）组（68例）。收集所有研究对象的临床资料和肝功能指标[丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TB）、白蛋白（Alb）]检测结果，同时检测血清IP-10、Gas6、CHI3L1水平。采用Spearman相关分析评估CHB患者IP-10、Gas6、CHI3L1水平与炎症程度和肝纤维化程度的相关性。采用多因素Logistic回归分析评估CHB患者发生显著性肝纤维化的影响因素。采用受试者工作特征（ROC）曲线评价IP-10、Gas6、CHI3L1判断CHB患者发生显著性肝纤维化的效能。结果 CHB组ALT、AST、TB、IP-10、CHI3L1水平高于正常对照组（P<0.001），Alb、Gas6水平低于正常对照组（P<0.001）。重度炎症组血清IP-10、CHI3L1水平高于轻度炎症组（P<0.001），血清Gas6水平低于轻度炎症组（P<0.001）。显著性纤维化组血清IP-10、CHI3L1水平高于非显著性纤维化组（P<0.001），血清Gas6水平低于非显著性纤维化组（P<0.001）。CHB患者血清IP-10、CHI3L1与肝脏炎症程度、纤维化程度均呈正相关（P<0.05），血清Gas6与肝脏炎症程度、纤维化程度均呈负相关（P<0.05）。IP-10、CHI3L1升高和Gas6降低均是CHB患者发生显著性肝纤维化的危险因素[比值比（OR）值分别为5.832、4.774、0.467，95%可信区间（CI）分别为2.611~13.026、2.704~8.428、0.328~0.665，P<0.001]。血清IP-10、Gas6、CHI3L1单项检测和联合检测判断CHB患者发生显著性肝纤维化的曲线下面积（AUC）分别为0.818、0.822、0.734、0.918。结论血清IP-10、Gas6、CHI3L1联合检测对CHB患者显著性肝纤维化有较高的诊断价值，或可作为CHB患者肝纤维化程度的评估指标。

关键词: γ-干扰素诱导蛋白10, 生长停滞特异性基因产物6, 壳多糖酶3样蛋白1, 肝纤维化, 慢性乙型肝炎

Abstract:

Objective To investigate the levels of serum interferon-gamma-induced protein-10（IP-10），growth arrest-specific gene 6（Gas6）and chitinase 3-like protein 1（CHI3L1）in patients with chronic hepatitis B （CHB），and to investigate their clinical significance. Methods A total of 148 patients with CHB（CHB group）and 148 healthy subjects（healthy control group）were enrolled from Nanyang Central Hospital from May 2022 to May 2024. The CHB patients were classified into mild inflammation（G1-G2 stage）group（69 cases）and severe inflammation（G3-G4 stage）group（79 cases）according to the degree of liver inflammation. The CHB patients were classified into significant liver fibrosis（S2-S4 stage）group（80 cases）and non-significant liver fibrosis（S1 stage）group（68 cases）according to the degree of liver fibrosis. The clinical data and the determination results of liver function indicators [alanine aminotransferase（ALT），aspartate aminotransferase（AST），total bilirubin（TB），albumin（Alb）] were collected，and the levels of serum IP-10，Gas6 and CHI3L1 were determined. Spearman correlation analysis was used to evaluate the correlation between the levels of IP-10，Gas6 and CHI3L1 in CHB patients and the degrees of liver inflammation and liver fibrosis. Multivariate Logistic regression analysis was used to analyze the influencing factors of significant liver fibrosis in CHB patients. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of IP-10，Gas6 and CHI3L1 in diagnosing significant liver fibrosis in CHB patients. Results The levels of ALT，AST，TB，IP-10 and CHI3L1 in CHB group were higher than those in healthy control group（P<0.001），while the levels of Alb and Gas6 were lower than those in healthy control group（P<0.001）. The serum IP-10 and CHI3L1 levels in severe inflammation group were higher than those in mild inflammation group（P<0.001），and the serum Gas6 level was lower than that in mild inflammation group（P<0.001）. The serum IP-10 and CHI3L1 levels in significant liver fibrosis group were higher than those in non-significant liver fibrosis group（P<0.001），and the serum Gas6 level was lower than that in non-significant liver fibrosis group（P<0.001）. The serum IP-10，CHI3L1 and liver inflammation degree，liver fibrosis degree in CHB patients were positively correlated（P<0.05），while the serum Gas6 was negatively correlated with liver inflammation degree，liver fibrosis degree（P<0.05）. Elevated IP-10 and CHI3L1 and decreased Gas6 were risk factors for significant liver fibrosis in CHB patients [odds ratios（OR）were 5.832，4.774 and 0.467，95% confidence intervals（CI）were 2.611-13.026，2.704-8.428 and 0.328-0.665，P<0.001]. The areas under curves（AUC）of single and combined determinations of serum IP-10，Gas6 and CHI3L1 for diagnosing significant liver fibrosis in CHB patients were 0.818，0.822，0.734 and 0.918，respectively. Conclusions The combined determination of serum IP-10，Gas6 and CHI3L1 has a high diagnostic value for significant liver fibrosis in CHB patients，which may be used for evaluating the degree of liver fibrosis in CHB patients.

Key words: Interferon-gamma-induced protein-10, Growth arrest-specific gene 6, Chitinase 3-like protein 1, Liver fibrosis, Chronic hepatitis B

中图分类号:

R446.1

王立坤, 李哲, 张萌, 牛俊强, 张晓虎. 血清IP-10、Gas6和CHI3L1联合检测诊断慢性乙型肝炎患者肝纤维化的价值[J]. 检验医学, 2026, 41(1): 14-19.

WANG Likun, LI Zhe, ZHANG Meng, NIU Junqiang, ZHANG Xiaohu. Diagnostic role of combined determination of serum IP-10，Gas6 and CHI3L1 for liver fibrosis in patients with chronic hepatitis B[J]. Laboratory Medicine, 2026, 41(1): 14-19.

图/表 8

参考文献 19

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组别	例数	性别		年龄/岁	饮酒史/例	吸烟史/例	ALT/ （U·L^-1）	AST/ （U·L^-1）	TB/ （μ mol·L^-1）	Alb/ （g·L^-1）
组别	例数	男/例	女/例	年龄/岁	饮酒史/例	吸烟史/例	ALT/ （U·L^-1）	AST/ （U·L^-1）	TB/ （μ mol·L^-1）	Alb/ （g·L^-1）
CHB组	148	75	73	51.35±6.08	77	76	82.44±8.32	88.35±8.87	25.88±4.25	28.22±3.34
正常对照组	148	72	76	50.28±5.22	75	70	20.33±4.38	22.74±5.21	8.92±3.51	40.84±3.46
统计值		0.122		1.624	0.054	0.487	80.362	77.592	37.432	31.925
P值		0.727		0.105	0.816	0.485	<0.001	<0.001	<0.001	<0.001

组别	例数	性别		年龄/岁	饮酒史/例	吸烟史/例	ALT/ （U·L^-1）	AST/ （U·L^-1）	TB/ （μ mol·L^-1）	Alb/ （g·L^-1）
组别	例数	男/例	女/例	年龄/岁	饮酒史/例	吸烟史/例	ALT/ （U·L^-1）	AST/ （U·L^-1）	TB/ （μ mol·L^-1）	Alb/ （g·L^-1）
CHB组	148	75	73	51.35±6.08	77	76	82.44±8.32	88.35±8.87	25.88±4.25	28.22±3.34
正常对照组	148	72	76	50.28±5.22	75	70	20.33±4.38	22.74±5.21	8.92±3.51	40.84±3.46
统计值		0.122		1.624	0.054	0.487	80.362	77.592	37.432	31.925
P值		0.727		0.105	0.816	0.485	<0.001	<0.001	<0.001	<0.001

组别	例数	IP-10/（pg·mL^-1）	Gas6/（pg·mL^-1）	CHI3L1/（ng·mL^-1）
CHB组	148	118.55±30.23	205.49±25.38	73.59±20.28
正常对照组	148	85.34±28.12	234.55±25.81	58.37±10.24
t值		9.786	9.767	8.150
P值		<0.001	<0.001	<0.001

组别	例数	IP-10/（pg·mL^-1）	Gas6/（pg·mL^-1）	CHI3L1/（ng·mL^-1）
CHB组	148	118.55±30.23	205.49±25.38	73.59±20.28
正常对照组	148	85.34±28.12	234.55±25.81	58.37±10.24
t值		9.786	9.767	8.150
P值		<0.001	<0.001	<0.001

组别	例数	IP-10/（pg·mL^-1）	Gas6/（pg·mL^-1）	CHI3L1/（ng·mL^-1）
轻度炎症组	148	109.43±20.23	219.19±12.33	65.97±9.37
重度炎症组	148	126.52±18.12	193.52±20.42	80.24±10.66
t值		5.421	9.092	8.592
P值		<0.001	<0.001	<0.001