超声弹性成像联合血清NOX2、CX3CL1诊断慢性乙型肝炎患者肝纤维化的临床价值

摘要/Abstract

摘要： 目的探讨超声弹性成像(UE)联合血清烟酰胺腺嘌呤二核苷酸磷酸氧化酶(NOX2)、CX3C趋化因子配体(CX3CL1)在慢性乙型肝炎(CHB)患者肝纤维化中的诊断价值。方法将2023年5月至2025年4月张家口市传染病医院收治的159例CHB患者设为研究组,根据显著性肝纤维化发生情况分为未发生组(n=64)和发生组(n=95)。另将137名健康者设为健康组。ELISA检测血清NOX2、CX3CL1水平。血清NOX2、CX3CL1与CHB患者肝纤维化分期的相关性通过Spearman法分析。采用多因素logistic回归分析评估CHB患者显著性肝纤维化的影响因素;采用受试者工作特征(ROC)曲线分析评价弹性模量值及血清NOX2、CX3CL1对CHB患者显著性肝纤维化的诊断价值。结果研究组血清NOX2水平(7.27±1.48 ng/mL)高于健康组(4.12±0.67 ng/mL,t=22.963,P<0.001),CX3CL1水平(6.83±1.42 ng/mL)低于健康组(9.05±1.49 ng/mL,t=13.109,P<0.001)。发生组弹性模量值(9.22±1.97 kPa)和血清NOX2水平(7.89±1.42 ng/mL)高于未发生组(6.63±1.12 kPa,6.36±1.04 ng/mL, t=9.526、7.385,P<0.001),CX3CL1水平(6.26±1.14 ng/mL)低于未发生组(7.68±1.37 ng/mL,t=7.096,P<0.001)。Spearman分析显示,血清NOX2、CX3CL1水平与CHB患者肝纤维化分期存在显著相关性(r=0.463、-0.440,P<0.05)。多因素logistic回归结果显示,CHB患者显著性肝纤维化的发生与CHB病程(OR=1.608)、丙氨酸氨基转移酶(ALT)(OR=1.419)、天冬氨酸氨基转移酶(AST)(OR=1.263)、NOX2(OR=2.032)和CX3CL1(OR=0.927)有关(P<0.05)。ROC结果显示,弹性模量值、血清NOX2、CX3CL1单独诊断的AUC分别为0.863、0.803和0.787,三个指标联合诊断CHB患者显著性肝纤维化的AUC(0.948)高于NOX2(Z=4.961,P<0.001)、CX3CL1(Z=4.941,P<0.001)单独诊断。结论 CHB患者血清NOX2较高、CX3CL1较低,UE检测的弹性模量值联合血清NOX2、CX3CL1对显著性肝纤维化具有较佳的诊断效能,对开发多模态诊断策略具有积极意义。

关键词: 慢性乙型肝炎, 肝纤维化, 超声弹性成像, 烟酰胺腺嘌呤二核苷酸磷酸氧化酶, CX3C趋化因子配体1, 诊断价值

Abstract: Objective To explore the diagnostic value of ultrasound elastography (UE) combined with serum levels of nicotinamide adenine dinucleotide phosphate oxidase (NOX2) and CX3C chemokine ligand (CX3CL1) for liver fibrosis in chronic hepatitis B (CHB) patients. Methods A total of 159 chronic hepatitis B (CHB) patients admitted to Zhangjiakou Infectious Disease Hospital from May 2023 to April 2025 were designated as the study cohort. They were separated into a non-occurrence group (n=64) and an occurrence group (n=95) based on whether the patients had significant liver fibrosis. Another 137 healthy individuals were designated as a healthy control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum NOX2 and CX3CL1. The correlation between serum NOX2, CX3CL1 and liver fibrosis staging in CHB patients was explored by Spearman method. Multivariate logistic regression was used to explore the influencing factors of significant liver fibrosis in CHB patients. ROC was used to explore and evaluate the diagnostic value of elastic modulus value and serum NOX2 and CX3CL1 for significant liver fibrosis in CHB patients. Results The research group had higher serum NOX2 (7.27±1.48 ng/mL vs. 4.12±0.67 ng/mL, t=22.963, P<0.001), and lower CX3CL1 than the healthy group (6.83±1.42 ng/mL vs. 9.05±1.49 ng/mL, t=13.109, P<0.001). The occurrence group had higher elastic modulus value and serum level NOX2 (9.22±1.97 kPa vs. 6.63±1.12 kPa, 7.89±1.42 ng/mL vs. 6.36±1.04 ng/mL, t=9.526, 7.385, P<0.001), and lower CX3CL1 than the non-occurrence group (6.26±1.14 ng/mL vs. 7.68±1.37 ng/mL, t=7.096, P<0.001). Spearman analysis showed a prominent correlation between serum NOX2 and CX3CL1 levels with the staging of liver fibrosis in CHB patients (r=0.463、-0.440, P<0.05). Multiple logistic regression showed that the occurrence of significant liver fibrosis in CHB patients was related to the course of CHB (OR=1.608), the levels of alanine aminotransferase (ALT) (OR=1.419), aspartate aminotransferase (AST) (OR=1.263), NOX2 (OR=2.032), and CX3CL1 (OR=0.927) (P<0.05). The results of receiver operating characteristic curve (ROC) analysis showed that the area under the curve (AUC) values of elastic modulus, serum NOX2 and CX3CL1 levels in the diagnosis of significant liver fibrosis in CHB patients were 0.863, 0.803, and 0.787, respectively. The AUC (0.948) for the combined diagnosis of these three indicators was higher than that of NOX2 (Z=4.961, P<0.001) and CX3CL1 (Z=4.941, P<0.001) alone in the diagnosis of significant liver fibrosis in CHB patients. Conclusion CHB patients have higher serum NOX2 and lower CX3CL1 levels. The elastic modulus value detected by UE combined with serum levels of NOX2 and CX3CL1 has good diagnostic efficacy for significant liver fibrosis, which is of positive significance for the development of multimodal diagnostic strategies.

Key words: Chronic hepatitis B, Liver fibrosis, Ultrasonic elastography, Nicotinamide adenine dinucleotide phosphate oxidase, CX3C chemokine ligand 1, Diagnostic value

刘燕霞, 梁占东, 吴博. 超声弹性成像联合血清NOX2、CX3CL1诊断慢性乙型肝炎患者肝纤维化的临床价值[J]. 肝脏, 2026, 31(8): 1096-1100.

Liu Yanxia, Liang Zhandong, Wu Bo. The clinical value of ultrasound elastography combined with serum levels of NOX2 and CX3CL1 in the diagnosis of liver fibrosis in chronic hepatitis B patients[J]. Chinese Hepatolgy, 2026, 31(8): 1096-1100.

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