| Objective: To compare the changes of inflammatory activity and serum cytokeratin 18(CK18)M30 and M65 levels in patients with HBV-related chronic liver diseases at different stages and their significance in clinical application,and to explore whether the detection level can be used as a sensitive serological indicator for judging liver inflammation and liver cirrhosis,so as to provide reliable basis for clinical improvement of diagnosis and treatment of HBV-related chronic liver diseases.To provide new ideas for the diagnosis and treatment of hepatitis B related liver diseases.Methods: From December 2017 to March 2019,100 subjects were collected from the infectious diseases department of the first affiliated hospital of Guangxi medical university,including 20 patients with hepatitis b virus,20 patients with chronic hepatitis b,20 patients with liver cirrhosis and 20 patients with acute-on-chronic liver failure.The control group consisted of 20 healthy persons collected from the physical examination center of the first affiliated hospital of Guangxi medical university during the same period.serum of all subjects was collected and analyzed by ELISA,The levels of cytokeratin18(CK18)M30 and M65 in serum of all subjects were determined by enzyme linked immunosorbent assay(ELISA).The virological data,biochemical indexes and other clinical data of each patient were collected,and the test results were analyzed by biological software and SPSS19.0 statistical software,with p<0.05 having statistical significance.Through the expression differences between the groups,the correlation between CK18-M30 and M65 and clinical indicators and the correlation between CK18-M30 and M65 and the severity of HBV-related chronic liver diseases were discussed.Results:1.CK18-M30 levels are different in the peripheral blood of healthy control group and patients with HBV-related chronic liver diseases.The levels are respectively 104.41 pg/ml(86.80 pg/ml,120.62 pg/ml)of healthy control group and 180.13 pg/ml(162.40 pg/ml)of HBV carrier group by using quartile spacing.196.30 pg/ml),212.89 pg/ml(187.80 pg/ml,291.32 pg/ml)in CHB group,272.85 pg/ml(251.58 pg/ml,291.32 pg/ml)in LC group and 486.86pg/ml(439.11 pg/ml,532.53 pg/ml)in ACLF group.The Kruskal-Wallis test with independent sample nonparametric test was used for two-two comparative analysis.It was found that there was no statistical difference between HBV carrying group and CHB group(p=0.115),but there was statistical difference between the other groups.2.CK18-M65 levels are different in the peripheral blood of healthy control group and patients with HBV-related chronic liver diseases.The levels are respectively 118.83 pg/ml(102.59 pg/ml,133.14 pg/ml)in healthy control group and 152.02 pg/ml(139.52 pg/ml)in HBV carrier group by using quartile spacing.164.38 pg/ml),162.95 pg/ml(153.68 pg/ml,177.62 pg/ml)in CHB group,203.62 pg/ml(191.78 pg/ml,222.93 pg/ml)in LC group and 628.39 pg/ml(569.18 pg/ml,713.60 pg/ml)in ACLF group.Kruskal-Wallis test using independent sample nonparametric test found that there was no statistical difference between the two groups except HBV carrying group and CHB group(P=0.234),while there was statistical difference between the other groups.3.By dividing patients with HBV-related chronic liver diseases into CHB group,LC group and ACLF group,a total of 60 samples of serum CK18-M30 levels were analyzed by Spearman correlation with age,ALT,AST,total bilirubin and albumin indexes.The results showed that serum CK18-M30 level was positively correlated with ALT,AST and total bilirubin(correlation coefficients r were 0.310,0.252 and 0.272,respectively,p<0.05),but was not correlated with albumin level and age(p>0.05).4.The peripheral serum HBV-DNA loads in each group of patients with HBV-related chronic liver diseases were HBV-carrying group(4.07±1.45),CHB group(5.17±1.59),LC group(5.93±1.63)and ACLF group(6.63±1.59),with statistically significant differences(p=0.000).The comparison between the two groups showed that there were significant differences between CHB group and ACLF group(p=0.004),CHB group and HBV carrying group(p=0.03),LC group and HBV carrying group(p=0.000),ACLF group and HBV carrying group(p=0.000).There was no statistical difference between CHB group and LC group(p=0.13),ACLF group and LC group(p=0.16).Spearman correlation analysis showed that CK18-M30 had a positive correlation with HBV-DNA load(r = 0.375,p=0.001),and CK18-M65 had a positive linear correlation with HBV-DNA load(r=0.445,p=0.000),with significant statistical differences.With the increase of HBV-DNA load,the levels of CK18-M30 and CK18-M65 also gradually increased.Through Spearman correlation analysis,we also found that CK18-M30 and CK18-M65 also showed positive linear correlation(r=0.862,p=0.000),the difference was statistically significant.5.M30 and M65 detected by CHB group,LC group and ACLF group are compared(M30/M65).Through one-way analysis of variance,we find that there are differences among the three groups of M30/M65,among which the differences among the values of M30/M65 in CHB group(1.29±0.14),LC group(1.32±0.16)and ACLF group(0.77±0.11)are statistically significant(p=0.000).After two-to-two comparisons between groups,it was found that there were statistically significant differences between CHB group and ACLF group(p=0.000),LC group and ACLF group(p=0.000).There was no significant difference between CHB group and LC group(p=0.550).Conclusion:1.There are significant differences between CK18-M30 and CK18-M65 in different types of HBV-related chronic liver diseases,which can be used as a supplement to non-invasive diagnostic methods for HBV-related liver diseases.2.M30/M65 value can be used to predict the development process of HBV infection of liver cells and the occurrence of chronic hepatitis B,liver cirrhosis and even liver failure,and provide help for the timely treatment of liver diseases. |
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