The Preliminary Study On The Predictive Value Of Ceruloplasmin In Diagnosising Complicated With Hepatic Steatosis Of Chronic Hepatitis B

Object: To investigate the diagnostic value of ceruloplasmin for the patients with chronic hepatitis B(CHB) complicating with hepatic steatosis and establish a noninvasive diagnosis model to predict hepatic steatosis, and then analyze their diagnostic value.Methods: Both liverbiopsy samples and sera were collected from 1514 consecutive CHB patients in Liver Center,First Affiliated Hospital,Fujian Medical University during January 2009 and June 2014. 395 cases of which were in line with inclusion and exclusion criteria and enrolled in this study. 367 enrolled cases of patients with CHB were divided into 136 cases of patients with CHB complicating hepatic stedatosis(Group A) and 231 cases of patients with CHB not complicating hepatic stedatosis(Group B), the rest 28 enrolled cases were fatty liver disease(Group C), then the serum CP in patients of above three groups were compared and analyzed. The correlation between CP and grade of pathology were determined by Spearman rank correlation analysis and diagnostic value of CP for the patients with CHB complicating hepatic steatosis was evaluated by receiver operator characteristic curve(ROC). Logistic regression analysis was used to assess the diagnosis significance of related indicators and build a predictive model for the diagnosis of hepatic steatosis. The corresponding diagnostic value were evaluated by ROC.Results: 1.The serum CP levels were different among Group A、B and C and differences were statistically significant(F = 26.951, P <0.01). Multiple comparisons of Dunnett’s T3 test for heterogeneity of variance was used for further pairwise comparisons and the results suggested that CP level in Group C(256.86 ± 84.27) mg/L was higher than that in Group A(209.52 ± 38.09) mg/L and Group B(197.83 ± 33.85) mg/L and the differences were statistically significant(P =0.02, P=0.003). Theserum CP levels of Group A(209.52 ± 38.09) mg/L were higher than that of Group B(197.83 ± 33.85) mg/L and the differences were statistically significant(P = 0.01). 2. The average serum CP in the CHB patients of G1, G2, G3, G4 of hepatitis activity were respectively(207.98 ± 38.05),(201.74 ± 35.73),(201.56 ± 34.43) and(185.31 ± 28.46) mg/L. One-way ANOVA analysis showed statistically significant differences of CP among the four groups of hepatitis activity grades(F = 3.417, P = 0.018) and the level of CP gradually declined with hepatitis activity grade increasing. The average serum CP in the CHB patients of S1, S2, S3 and S4 of fibrosis stage were respectively(209.49 ± 35.26),(207.63 ± 36.72),(193.30 ± 34.78) and(186.89 ± 30.17) mg/L. One-way ANOVA analysis demonstrated that statistically significant differences of CP among the four groups of fibrosis stages( F = 7.849, P <0.01) and the CP level gradually declined with fibrosis stage increasing. The average serum CP in the NAFLD patients of F0, F1, F2 and F4 of hepatic steatosis degree were respectively(197.83 ± 33.85),( 203.06 ± 35.02),(218.10 ± 41.65) and(222.08 ± 38.93) mg/L and displayed statistically significant differences of CP among the four groups of steatosis degrees( F = 7.849, P <0.01), the CP level gradually increased with the fibrosis stage increasing. Spearman rank correlation analysis indicated that serum CP were negatively correlated with the grade of hepatitis activity(r =-0.123, P = 0.018) and fibrosis stage(r =-0.234, P <0.01) while positively correlated with the steatosis degree(r = 0.150, P <0.01). 3. Diagnostic curves of CP on the F≥1, F≥2 and F≥3 were respectively built by ROC and the corresponding areas under curve of receiver operator characteristic curve(AUROC) were 0.574, 0.638 and 0.738 respectively. 4. CP, Age, TCHO, HDL, LDL, ALB and PLT in the Model-F-1(F≥1), Model-F-2(F≥2) and Model-F-3(F≥3) were screened as independent predictors for hepatic steatosis by Logistic regression analysis., the corresponding AUROC were 0.767,0.805 and 0.815 and the ad AUROC were 0.823,0.861 and 0.871 respectively after correction of DANA formula.Conclusions: Serum CP in patients with NAFLD was higher than that in patients with CHB and CP in patients with CHB complicating hepatic steatosis was higher than that in patients with CHB not complicating hepatic steatosis. CP in patients withCHB was negatively correlated with the grade of hepatitis activity and the stage of fibrosis as well as positively correlated with the degree of hepatic steatosis. Single factor of serum CP defined a certain predictive value for the diagnosis of CHB complicating hepatic steatosis and incorporation of CP to establish a prediction mode for hepatic steatosis presented a certain diagnostic value.