[Diagnostic value of serum chitinase-3-like protein 1 in chronic liver disease of significant fibrosis and cirrhosis].

Objective: To study the correlation between the level of serum Chitinase-3-like protein 1 (CHI3L1) and the significant liver fibrosis and liver cirrhosis in patients with chronic liver disease, and to evaluate its diagnostic value. Methods: 165 patients with chronic liver disease were selected, liver histopathological examination was performed to detect serum CHI3L1 concentration. Four indexes of hepatic fibrosis (type III procollagen, collagen IV, laminin, hyaluronic acid), aspartate aminotransferase/platelet ratio index (APRI) and FIB-4 (fibrosis- 4) scores were based on the pathological findings of liver biopsy and compared the advantages and disadvantages of serum CHI3L1 with other methods for the diagnosis of hepatic fibrosis and liver cirrhosis. A multivariate regression analysis model was created, and receiver operating characteristic curve was analyzed. Results: The level of serum CHI3L1 increased with increase of fibrosis stage and was highest in liver cirrhosis stage. In the period of S0 to 1, the levels of S2 to 3 and S4 were 62.82 (41.40 ~ 87.20), 70.94 (48.47 to 122.60) and 141.06 (78.18 ~ 197.40), and there were statistically significant differences between the groups (P < 0.001). The area under the curve for the diagnosis of significant liver fibrosis was 0.68 (0.60 to 0.77), and 0.74 (0.65 to 0.83) for cirrhosis in CHI3L1. Multivariate regression analysis showed that CHI3L1 was an independent predictor of significant fibrosis and cirrhosis. The combined diagnostic model based on CHI3L1, collagen IV and FIB-4 scores further improved the diagnostic value. The area under the curve for the diagnosis of significant fibrosis and cirrhosis was 0.79 (0.72 to 0.86) and 0.80 (0.73 to 0.87), respectively. Conclusion: CHI3L1 has a good diagnostic value in patients with chronic liver disease with significant fibrosis and liver cirrhosis. The diagnostic model in combination with other markers like Collagen IV and FIB-4 scores could further improve the diagnostic value and is worthy of further study.目的： 研究慢性肝病患者血清壳多糖酶3样蛋白1（CHI3L1）水平与显著肝组织纤维化和肝硬化的相关性，并对其诊断价值进行评价。 方法： 收集165例慢性肝病患者资料，均进行肝组织病理学检查，检测血清CHI3L1浓度、肝纤维化4项指标（Ⅲ型前胶原、Ⅳ型胶原、层黏连蛋白、透明质酸）及天冬氨酸氨基转移酶/血小板比值指数和FIB-4评分，以肝穿刺病理结果为依据，比较血清CHI3L1与其他几种方法对显著肝纤维化和肝硬化诊断的优劣。用多因素logistic逐步回归分析进行模型筛选和构建，用受试者工作特征曲线进行分析。 结果： 血清CHI3L1水平随着纤维化分期增加而增加，并在肝硬化期最高，在S0～S1期，S2～S3期和S4期的水平分别为62.82 （41.40～87.20），70.94（48.47～122.60）和141.06（78.18～197.40），组间差异均有统计学意义（P值均< 0.001）。CHI3L1对显著纤维化诊断的受试者工作特征曲线下面积为0.68（0.60～0.77），对肝硬化的诊断为0.74（0.65～0.83）。利用多因素logistic分析矫正混杂因素后，结果显示CHI3L1是显著纤维化和肝硬化的独立预测指标。基于CHI3L1，Ⅳ型胶原以及FIB-4构建的联合诊断模型能够进一步提升诊断价值，诊断显著纤维化和肝硬化的曲线下面积分别为0.79（0.72～0.86）和0.80（0.73～0.87）。 结论： CHI3L1在慢性肝病显著纤维化，肝硬化中有良好的诊断价值，联合现有的其他标志物Ⅳ型胶原和FIB-4评分所构建的诊断模型可进一步提升诊断价值，值得进一步深入研究。.