Clinical Significance Of Serum Protoporphyrin ? Detection In Patients With HBV-related Chronic Liver Disease

ObjectiveTo investigate the clinical significance of serum Protoporphyrin? (PP? )detection in liver function impairment of patients with hepatitis B virus(HBV)related chronic liver disease,and to determine whether the level of serum PP? can be used as a sensitive parameter for early warning and disease assessment of liver damage in patients with chronic liver disease.MethodsPatients diagnosed with HBV-related chronic liver disease in the First Affiliated Hospital of Xi'an Medical university from October 2018 to October 2019 were recruited as the case group,including 50 patients with chronic hepatitis B virus(CHB),40 patients with hepatic cirrhosis(HC),and 20 patients with hepatocellular carcinoma(HCC).In the same period,40 healthy people were recruited from the physical examination department of our hospital as the control group.In this experiment,high performance liquid chromatography(HPLC)was used to detect the serum PPIX concentration of all subjects,and laboratory indicators such as liver function and coagulation were measured according to conventional methods.The serum PP? levels in patients with liver disease and healthy people were compared,and the diagnostic value of PP? for HBV-related chronic liver disease and the correlation between PP? and various laboratory indicators were analyzed.Results1.(1)Comparison of serum PP? in liver disease group and control group:The serum PP? in the three liver disease groups of CHB,HC and HCC were significantly higher than that in the control group,44.29(25.99,85.36),72.73(48.28,90.43),91.79(68.34,121.52)vs 15.43(10.87,20.16)ng/dl,all the differences were statistically significant(P<0.05).Although the HC group had higher PP? than the CHB group,the difference was not statistically significant(P>0.05);while the serum PP? in the HCC group were significantly higher than that in the CHB and HC groups(P<0.05).(2)Comparison of serum PP? in CHB and HC patients:Patients with CHB are further divided into stationary and active phases,and patients with HC are divided into compensated and decompensated phases.Compared with compensated phase of HC,serum PP? in decompensated patients was significantly higher(P<0.05),while in patients with CHB,there was no significant difference in PPIX between active phase and stationary phase(P>0.05).And there was no significant difference in PP? between the compensated phase of HC and the stationary phase of CHB patients,and between the decompensated patients and the active phase of CHB patients(P>0.05).But the serum PP? in decompensated phase of HC were significantly higher than those in the stationary phase of CHB patients(P>0.05).2.The ROC curve shows that the area under the curve(AUC)for PP? diagnosis of CHB is 0.873,and the critical value was determined using the Jordan index to 20.325ng/dl,with a sensitivity of 86%and a specificity of 77.5%.The AUC for diagnosing HC is 0.748,and the cut-off is 33.695ng/dl,with a sensitivity of 90%and a specificity of 61.1%;And the AUC for diagnosing HCC is 0.812,and the cut-off is 65.26ng/dl,with a sensitivity of85%and a specificity of 69.2%.3.(1)Comparison of laboratory indicators between different liver disease groups:The AFP in the HCC group was significantly higher than that in the CHB and HC groups(P>0.05),however,the other laboratory indicators had no significant difference between the HCC group and the HC group(P>0.05).Compared with the CHB group,the TBIL,GGT,and PT were significantly increased,and the PLT,CHE,ALB,and PT%were significantly decreased in the HC group and the HCC group(P<0.05).However,there were no significant differences in the HBV-DNA,ALT and ALP between the three groups(P>0.05).(2)Comparison of PP? and liver function indicators between the stationary phase of CHB patients and the control group:The level of PP? in the stationary phase of CHB patients was significantly higher than that in the control group(P<0.05),while except for the slight increase in CHE,the other liver function indicators had no significant difference between the two groups(P>0.05).4.Correlation between PP? and various indicators showed that there was no significant correlation between PP? and each indicators in patients with CHB(P>0.05).In patients with HC,the PP? was positively correlated with the age,AFP,TBIL and AST(P<0.05),and negatively correlated with the PLT,CHE,and ALB(P<0.05).Only moderately positively correlated with TBIL(r_s=0.587,P<0.05)and moderately negatively correlated with ALB(r_s=-0.408,P<0.05),and the rest were weakly correlated(r_s<0.4,P<0.05).PP? was moderately positively correlated with TBIL(r_s=0.470,P<0.05)and moderately negatively correlated with CHE(r_s=-0.459,P<0.05)in HCC patients.Conclusions1.The serum PP? level in patients with HBV-related chronic liver disease was significantly higher than that in the control group,and it was activity-dependent with the progression of chronic liver disease.2.Serum PP? can be used as a sensitive parameter for early warning and condition assessment of liver damage in patients with HBV-related chronic liver disease.