自身免疫性肝炎患者血清CXCL13、CHI3L1水平变化及其临床意义

摘要/Abstract

摘要： 目的探究自身免疫性肝炎(AIH)患者血清趋化因子配体13(CXCL13)、壳多糖酶3样蛋白1(CHI3L1)水平变化及其临床意义。方法选取2022年7月至2024年7月期间在本院初次诊断为AIH的115例患者作为AIH组,按照不同AIH分期,分为活动期组61例、缓解期组54例;按照不同AIH病情严重程度,分为轻度组37例、中度组46例、重度组32例。另外,选取同期健康体检者115名作为对照组。采用酶联免疫吸附法(ELISA)测定血清CXCL13、CHI3L1表达水平;应用logistic回归分析确定影响 AIH 患者病情严重程度的因素;应用ROC曲线评估CXCL13、CHI3L1在AIH患者病情严重程度方面的诊断效能。结果 AIH组患者血清CXCL13、CHI3L1表达水平分别为(287.82±31.76)pg/mL、(739.27±64.51)pg/mL,高于对照组的(212.15±26.21)pg/mL、(575.54±52.48)pg/mL(P<0.05)。随着AIH患者病情严重程度的增加,血清CXCL13、CHI3L1水平方面,轻度组(261.62±29.73)pg/mL、(682.14±61.38)pg/mL,中度组(284.45±31.48)pg/mL、(744.15±64.41)pg/mL,重度组(322.97±34.52)pg/mL、(798.31±68.26)pg/mL均逐渐显著增加(P<0.05)。缓解期组和活动期组患者丙氨酸氨基转移酶[(122.14±5.31)U/L比(72.25±2.29)U/L]、天冬氨酸氨基转移酶[(166.37±5.86)U/L比(79.87±3.78)U/L]、CXCL13[(308.51±32.92)pg/mL比(264.44±30.45)pg/mL]、CHI3L1[(771.49±68.14)pg/mL比(702.87±60.41)pg/mL]差异均有统计学意义(P<0.05)。Logistic回归分析显示,CXCL13、CHI3L1是影响AIH 患者病情严重程度的危险因素(OR＞1,P<0.05)。血清CXCL13、CHI3L1二者联合诊断AIH 患者病情严重程度的AUC最高,效果优于各自单独诊断(Z_{二者联合-CXCL13}=2.093、P= 0.036,Z_{二者联合-CHI3L1}=3.295、P=0.001),灵敏度为75.00%,特异度为95.18%。结论 AIH患者血清CXCL13、CHI3L1水平显著升高,二者联合可以更好地诊断AIH 患者病情严重程度。

关键词: 自身免疫性肝炎, CXCL13, CHI3L1, 诊断

Abstract: Objective To investigate the changes and clinical significance of serum levels of chemokine C-X-C motif ligand 13 (CXCL13) and chitinase-3-like protein 1 (CHI3L1) in patients with autoimmune hepatitis (AIH). Methods This study selected 115 patients diagnosed with AIH for the first time in our hospital from July 2022 to July 2024 as the AIH group. According to different stages of AIH, the patients were further divided into the active group (61 cases) and the remission group (54 cases). According to the severity of AIH, the patients were classified into the mild group (37 cases), moderate group (46 cases) and severe group (32 cases). In addition, 115 individuals who underwent physical health examinations were selected as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to measure the expression levels of serum CXCL13 and CHI3L1. Logistic regression was applied to analyze factors affecting the severity of AIH. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of CXCL13 and CHI3L1 in the severity of AIH patients. Results The serum levels of CXCL13 and CHI3L1 in patients with AIH were (287.82±31.76) pg/mL and (739.27±64.51) pg/mL, respectively, which were higher than those in control group (212.15±26.21) pg/mL and (575.54±52.48) pg/mL (P<0.05). With the aggravation of AIH severity, the serum levels of CXCL13 and CHI3L1 increased significantly in mild group (261.62±29.73) pg/mL, (682.14±61.38) pg/mL, moderate group (284.45±31.48) pg/mL, (744.15±64.41) pg/mL and severe group (322.97±34.52) pg/mL,(798.31±68.26) pg/mL (P<0.05). Alanine aminotransferase[(122.14±5.31) U/L vs. (72.25±2.29)U/L], aspartate aminotransferase[(166.37±5.86) U/L vs. (79.87±3.78) U/L], CXCL13[(308.51±32.92) pg/mL vs. (264.44±30.45) pg/mL] and CHI3L1[(771.49±68.14) pg/mL vs. (702.87±60.41) pg/mL] in remission group and active group were significantly different (P<0.05). Logistic analysis showed that CXCL13 and CHI3L1 were risk factors affecting the severity of AIH patients (OR＞1, P<0.05). The AUC of the combined diagnosis of serum CXCL13 and CHI3L1 for the severity of AIH patients was the highest, superior to the individual diagnosis of CXCL13 and CHI3L1 (Z_{combination-CXCL13}=2.093, P=0.036, Z_{combination-CHI3L1}=3.295, P=0.001), with a sensitivity of 75.00% and a specificity of 95.18%. Conclusion The levels of serum CXCL13 and CHI3L1 are obviously elevated in AIH patients, and their combination can better evaluate the severity of AIH patients.

Key words: Autoimmune hepatitis, CXCL13, CHI3L1, Diagnosis

鲍琢, 包玉荣, 奥敦托娅. 自身免疫性肝炎患者血清CXCL13、CHI3L1水平变化及其临床意义[J]. 肝脏, 2026, 31(1): 54-58.

BAO Zhuo, BAO Yu-rong, Aoduntuoya. Changes and clinical significance of serum CXCL13 and CHI3L1 levels in patients with autoimmune hepatitis[J]. Chinese Hepatolgy, 2026, 31(1): 54-58.

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