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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (5): 582-589.doi: 10.3969/j.issn.1674-5671.2025.05.09

• 论著 • 上一篇    下一篇

血清壳多糖酶3样蛋白1水平对乙型肝炎病毒相关肝细胞癌的辅助诊断价值

  

  1. 广西医科大学附属肿瘤医院临床研究部；广西医科大学附属肿瘤医院伦理委员会办公室；广西医科大学附属肿瘤医院肿瘤防控办公室；浙江大学浙江加州国际纳米枝术研究院；华盛顿大学医学院；广西医科大学附属肿瘤医院实验研究部；区域性高发肿瘤早期防治研究教育部重点实验室（广西医科大学）；广西区域性高发肿瘤早期防治研究重点实验室；广西壮族自治区卫生健康委员会肿瘤分子医学重点（培育）实验室（广西医科大学附属肿瘤医院）；广西壮族自治区肿瘤分子医学工程研究中心；广西医科大学附属肿瘤医院疾病流程管理办公室
  • 出版日期:2025-10-25 发布日期:2025-12-03
  • 通讯作者: 余红平 E-mail:yuhongping@stu.gxmu.edu.cn；梁秀妹 E-mail: 1697316304@qq.com
  • 基金资助:
    广西医疗卫生适宜技术开发与推广应用项目（S2022112；S2021022）；国家重点研发计划资助项目（2022YFA1303801）

Auxiliary diagnostic value of serum chitinase-3-like protein 1 levels in hepatitis B virus-related hepatocellular carcinoma

  • Online:2025-10-25 Published:2025-12-03

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摘要： 目的 评估血清壳多糖酶3样蛋白1（chitinase⁃3⁃like protein 1，CHI3L1）在乙型肝炎病毒（hepatitis B virus，HBV）相关肝细胞癌（hepatocellular carcinoma，HCC）中的辅助诊断价值。方法 纳入654例HBV相关HCC患者、408例慢性乙型肝炎（chronic hepatitis B，CHB）患者及551例表观健康对照人群（apparently healthy control，AHC），检测血清CHI3L1、甲胎蛋白（alpha fetoprotein，AFP）、甲胎蛋白异质体（alpha⁃fetoprotein⁃L3，AFP⁃L3）及异常凝血酶原（des⁃γ⁃carboxy prothrombin，DCP）水平，绘制受试者工作特征（receiver operating characteristic，ROC）曲线，采用灵敏度、特异度、曲线下面积（area under the curve，AUC）评估各血清生物标志物在HBV相关HCC中的辅助诊断价值。结果 HCC组血清中的CHI3L1（156.16 ng/mL）、AFP（125.29 ng/mL）、AFP⁃L3（14.96 ng/mL）、DCP（359.75 ng/mL）水平显著高于CHB组和AHC组（均P<0.001）。单独使用上述4种血清标志物辅助诊断HBV相关HCC、早期HCC及小肝癌时， AFP显示出最高的AUC值；而将AFP与AFP⁃L3、DCP及CHI3L1联合后，诊断效能显著提升。对于AFP阴性（<20 ng/mL）的HBV相关HCC患者，CHI3L1联合DCP的补充诊断效能（以AHC为对照组：AUC=0.938；以CHB为对照组：AUC=0.878）优于任一单指标（以AHC为对照组：CHI3L1 AUC=0.888，DCP AUC=0.763；以CHB为对照组：CHI3L1 AUC=0.769，DCP AUC=0.789）。结论 CHI3L1与临床常用生物标志物（AFP、AFP⁃L3、DCP）联合检测可显著提升HBV相关HCC的辅助诊断效能，尤其对早期HCC、小肝癌和AFP阴性病例具有重要的辅助诊断价值。

关键词: 壳多糖酶3样蛋白1, 肝细胞癌, 小肝癌, 乙型肝炎病毒, 甲胎蛋白

Abstract: Objective To investigate the auxiliary diagnostic value of serum chitinase⁃3⁃like protein 1 (CHI3L1) in hepatitis B virus (HBV)⁃related hepatocellular carcinoma (HCC). Methods A total of 654 patients with HBV⁃related HCC, 408 patients with chronic hepatitis B (CHB), and 551 apparently healthy individuals (AHC) were enrolled. The levels of serum CHI3L1, alpha⁃fetoprotein (AFP), alpha⁃fetoprotein variant L3 (AFP⁃L3), and des⁃γ⁃carboxy prothrombin prothrombin (DCP) were quantified. Receiver operating characteristic (ROC) curves were plotted. The sensitivity, specificity, and area under the curve (AUC) were used to determine the anxiliary diagnostic value of each serum biomarker in identifying HBV⁃related HCC. Results The levels of serum CHI3L1 (156.16 ng/mL), AFP (125.29 ng/mL), AFP⁃L3 (14.96 ng/mL), and DCP (359.75 ng/mL) were significantly elevated in the HCC group compared to the CHB and AHC groups (all P<0.001). In the context of  auxiliary diagnosis for HBV⁃related HCC, early⁃stage HCC, and small HCC using individual biomarkers, AFP yielded the highest AUC among the four biomarkers. Nevertheless, the diagnostic efficacy was significantly improved when AFP combined with AFP⁃L3, DCP, and CHI3L1. For HBV⁃related HCC patients who are AFP⁃negative (<20 ng/mL), the supplementary diagnostic efficacy of the combination of CHI3L1 and DCP (AHC control group : AUC=0.938; CHB control group : AUC=0.878)  outperformed individual biomarkers ( AHC control group: CHI3L1 AUC=0.888, DCP AUC=0.763; CHB control group: CHI3L1 AUC=0.769, DCP AUC=0.789). Conclusions The integration of CHI3L1 and commonly clinical biomarkers (AFP, AFP⁃L3, DCP) can significantly enhances the auxiliary diagnostic efficacy for HBV⁃related HCC, with particularly demonstrating critical value for early⁃stage HCC, small HCC, and AFP⁃negative cases.

Key words: Chitinase?3?like protein 1, Hepatocellular carcinoma, Small hepatocellular carcinoma, Hepatitis B virus, Alpha fetoprotein

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