ApoB/ApoA1、25-（OH）D预测原发性胆汁性肝硬化病情的临床意义

Clinical significance of ApoB/ApoA1 and 25-(OH)D in predicting the severity of primary biliary cirrhosis

摘要:

目的 探讨载脂蛋白B/载脂蛋白A1（ApoB/ApoA1）、25-羟基维生素D［25-（OH）D］在原发性胆汁性肝硬化（PBC）患者中的临床意义。方法 选取2017年6月—2021年10月河南大学淮河医院收治的145例患者作为PBC组，另选取同期在该院体检的100例健康者作为对照组。对比两组临床资料和ApoB/ApoA1、25-（OH）D水平。依据PBC组病情严重程度分为重度病情组（43例）和轻中度病情组（102例）。比较重度病情组和轻中度病情组临床资料和ApoB/ApoA1、25-（OH）D水平。分析PBC患者病情严重程度的影响因素，绘制受试者工作特征（ROC）曲线，以曲线下面积（AUC）分析ApoB/ApoA1、25-（OH）D及两者联合对PBC患者病情严重程度的诊断价值。结果 PBC组ApoB/ApoA1高于对照组（P <0.05），25-（OH）D则低于对照组（P <0.05）。重度组合并高脂血症占比、谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、谷氨酸转氨酶（ALT）、天门冬氨酸氨基转移酶（AST）、透明质酸（HA）、层黏蛋白（LN）、Ⅲ型前胶原（PCⅢ）及ApoB/ApoA1高于轻/中度组（P <0.05），25-（OH）D则低于轻/中度组（P <0.05）。逐步多因素Logistic回归分析显示，合并高脂血症［O^R=3.053（95% CI：1.288，7.237）、ApoB/ApoA1［O^R=3.184（95% CI：1.343，7.548）］及25-（OH）D［O^R=3.377（95% CI：1.424，8.006）］均为影响PBC患者病情严重程度的影响因素（P <0.05）。ROC曲线分析结果显示，ApoB/ApoA1、25-（OH）D及两者联合对PBC患者病情严重程度预测的敏感性分别为74.42%（95% CI：58.53，85.96）、72.09%（95% CI：56.09，84.17）、69.77%（95% CI：53.70，82.33），特异性分别为66.67%（95% CI：56.56，75.50）、70.59%（95% CI：60.62，78.98）、98.04%（95% CI：92.41，99.66），AUC分别为0.668（95% CI：0.585，0.744）、0.727（95% CI：0.647，0.797）、0.883（95% CI：0.820，0.931）。结论 ApoB/ApoA1、25-（OH）D水平与PBC患者病情严重程度有关，且两者联合对PBC患者病情严重程度的诊断效能较高。

Abstract:

Objective To investigate the clinical significance of apolipoprotein B/A1 (ApoB/ApoA1) and 25-hydroxyvitamin D [25-(OH)D] in patients with primary biliary cirrhosis (PBC).Methods A total of 145 PBC outpatients and inpatients admitted to Huaihe Hospital of Henan University from June 2017 to October 2021, and another 100 healthy people who received health checkup in the hospital during the same period were selected and recorded as the PBC group and the control group, respectively. The clinical data and levels of ApoB/ApoA1 and 25-(OH)D were compared between the two groups. The patients in the PBC group were further divided into severe disease group (43 cases) and mild to moderate disease group (102 cases), and the clinical data and levels of ApoB/ApoA1 and 25-(OH)D were also compared between the subgroups. The factors affecting the severity of PBC patients were analyzed. The predictive values of ApoB/ApoA1, 25-(OH)D and their combination for the severity of PBC patients were analyzed with the area under the receiver operating characteristic (ROC) curve (AUC).Results The level of ApoB/ApoA1 in the PBC group was higher than that in the control group (P < 0.05), while the level of 25-(OH)D in the study group was lower than that in the control group (P < 0.05). The proportion of hyperlipidemia, and levels of glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), glutamate aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronic acid (HA), laminin (LN), procollagen type III (PCIII) and ApoB/ApoA1 in the severe disease group were higher than those in the mild to moderate disease group (P < 0.05), whereas the level of 25-(OH)D in the severe disease group was lower than that in the mild to moderate disease group (P < 0.05). Multivariate analysis showed that patients with hyperlipidemia [O^R = 3.053 (95% CI: 1.288, 7.237) ], the level of ApoB/ApoA1 [O^R = 3.184 (95% CI: 1.343, 7.548) ] and the level of 25-(OH)D [O^R = 3.377 (95% CI: 1.424, 8.006) ] were factors affecting the severity of PBC patients (P < 0.05). The results of ROC curve analysis revealed that the sensitivities of levels of ApoB/ApoA1, 25-(OH)D and their combination in predicting the severity of PBC patients were 74.42% (95% CI: 58.53, 85.96), 72.09% (95% CI: 56.09, 84.17), and 69.77% (95% CI: 53.70, 82.33), with the specificities being 66.67% (95% CI: 56.56, 75.50), 70.59% (95% CI: 60.62, 78.98), and 98.04% (95% CI: 92.41, 99.66), and AUCs being 0.668 (95% CI: 0.585, 0.744), 0.727 (95% CI: 0.647, 0.797), and 0.883 (95%CI: 0.820, 0.931), respectively.Conclusions The levels of ApoB/ApoA1 and 25-(OH)D are related to the disease severity of PBC patients, and the combination of levels of ApoB/ApoA1 and 25-(OH)D has a higher predictive power for the disease severity of PBC patients.