Value Of CK18-M30 And CK18-M65 In Diagnosis Of NAFLD And Chronic HBV Infection

Object To explore the value of CK18-M30 and CK18-M65 in clinical diagnosis and disease progression assessment of patients with NAFLD,chronic HBV infection and chronic HBV infection combined with NAFLD.Methods From January 2017 to october 2018,159 inpatients in Tianjin Second People's Hospital were selected,including 21 cases of NAFLD,57 cases of chronic HBV infection and 81 cases of chronic HBV infection combined with NAFLD.All patients underwent liver biopsy,and the specimens were independently and blindly read by two pathologists in pathology department of our hospital.The clinical data,laboratory results and blood samples were collected.Serum CK18-M30 and CK18-M65 levels were measured by ELISA in all patients.The patients were grouped according to pathological data,the CK18 and clinical data were analyzed by SPSS22.0 statistical software.Results1.CK18-M30 was positively correlated with NAS,intralobular inflammation,ALT and AST in patients with NAFLD,r were 0.546,0.518,0.712 and 0.586.But it was not related to hepatic steatosis and hepatocyte balloon-like degeneration.2.CK18-M30 level was higher in severe fibrosis patients with NAFLD(P<0.05).The cut-off value of CK18-M30 for distinguishing mild fibrosis from moderate and severe fibrosis was 174.6U/L,with sensitivity of 0.615 and specificity of 1.3.CK18-M65 was not associated with NAS,intralobular inflammation,ALT and AST in NAFLD patients.4.CK18-M30 and CK18-M65 in patients with active HBV infection were higher than those in non-active HBsAg carriers(P<0.01).CK18-M30 and CK18-M65 can distinguish inactive HBsAg carriers from active HBV infection patients:CK18-M30 truncation value is 62.72U/L,sensitivity is 0.79,specificity is 0.6;CK18-M65 truncation value is 441.41U/L,sensitivity is 0.46,specificity is 1.The sensitivity of CK18-M30 is similar to that of ALT and AST,but the specificity is slightly lower.The sensitivity of CK18-M65 is lower than ALT and AST,but it has higher specificity.5.CK18-M30 and CK18-M65 levels in chronic HBV infection patients with positive HBeAg were higher than those patients with negative HBeAg(P<0.05).6.CK18-M30 was positively correlated with pathological inflammation grade G,ALT and ?GT in patients with chronic HBV infection.The r were 0.363,0.327and0.453,respectively.7.CK18-M65 levels in chronic HBV infection patients at immune clearance stage were positively correlated with pathological inflammation grade G,ALT and lg(HBV-DNA),and the r were 0.314,0.446 and 0.333,respectively.8.CK18-M30 levels in inactive HBsAg combined with NASH were higher than those in inactive HBsAg carriers(P<0.01).9.CK18-M30 levels in inactive HBsAg combined with NASH were higher than those in inactive HBsAg combined with NAFL(P<0.05).10.CK18-M30 and CK18-M65 levels in patients with active HBV infection combined with NAFL were higher than inactive HBsAg carriers combined with NAFL(P<0.05).Conclusions1.CK18-M30 is associated with NASH occurrence in patients with NAFLD and inflammation activity in patients with chronic HBV infection;CK18-M65 is associated with inflammation activity in patients with chronic HBV infection,but is not associated with NASH occurrence in patients with NAFLD.2.CK18-M30 has a certain value in distinguishing the degree of fibrosis in NAFLD patients.3.The level of CK18-M65 during immune clearance in patients with chronic HBV infection is related to the viral load.