Expressions Of CK18 And CK19 In HBV Infection Induced Chronic Liver Diseases

ObjectiveThe aim of this study was to investigate the expressions of CK18 and CK19 in HBV infection induced chronic liver diseases, to assess the diagnostic and staging value of CK18 in HBV infection induced chronic liver diseases, and to further explore hepatocyte death manners in the process of chronic HBV infection and development of HCC, and meanwhile to evaluate the single and combined efficiency of CK19 in HCC diagnosis. So as to provide new non-traumatic indexes for the diagnosis and staging of HBV infection induced chronic liver diseases.MethodsHBV carriers, patients with CHB or CHB combined NAFLD, and patients with liver cirrhosis or HCC caused by HBV who visited the second people’s hospital but did not receive systemic treatment were enrolled in our study. Those who visited for general check-up without hepatic diseases during the same period were selected as control group. The levels of serum CK18(M30 and M65) of the participants were detected by ELISA and compared among groups. Correlations of M30, M65 and indicators commonly used clinically were analyzed, and diagnostic and staging value of CK18 in HBV infection induced chronic liver diseases was evaluated. Furthermore, the levels of serum CK19(CYFRA21-1) of the HBV carriers, CHB patients and patients with LC or HCC caused by HBV were detected by ELISA and compared. ROC curve was constructed to evaluate the single and combined diagnostic value of CK19 in HCC diagnosis.Results1. There was no statistical differences of M30(/M65) between HBV carriers and healthy control. While level and positive rate of M30(/M65) were higher in the CHB, LC and HCC groups than that in control group and HBV carrier group. The difference was statistically significant.2. There was no statistical differences of M30(/M65) between CHB and CHB combined NAFLD patients.3. The M30 level and percentage of positive M30 were higher in moderate and severeCHB than that in mild CHB. And The levels of M30 and M65 of middle and advanced HCC was higher than those of early HCC.4. There was positive correlation between serum CK18-M30 and CK18-M65 in patients with HBV infection induced chronic liver diseases(r=0.803,P < 0.01).5. Serum M30 was positively correlated with ALT, AST, GGT, ALP, TBIL and AFP, and was negatively correlated with Alb. Serum M65 was positively correlated with ALT, AST, GGT, ALP, TBIL, AFP and age, and was negatively correlated with Alb. Multiple linear regression analysis indicated that GGT and AST were influence factors of M30, and TBIL and GGT were influence factors of M65.6. Detection rates of serum CK19 in control group, CHB group, LC group and HCC group were 8%,8%,26%,48%(P< 0.01). The percentage of detected CK19 was higher in decompensated LC patients than that in compensated LC patients.7. The areas under the ROC curves of single CK19, single AFP and combined monitor in HCC diagnosis were 0.668, 0.785 and 0.829. The cut-off point of CK19 was 0.360 ng/m L,with a 48% sensitivity and 84% specificity. And the sensitivity and specificity of combined diagnosis were 68% and 89%.Conclusions1. Levels of serum CK18-M30 and CK18-M65 in different stages of HBV infection induced chronic liver diseases are very significantly different, and they have good consistency respectively with indicators commonly used clinically, which suggests M30 and M65 are likely to be used as new non-traumatic indexes for the diagnosis and staging of chronic liver diseases.2. M30 and M65 are not specific enough for the diagnosis and staging of liver diseases, which could not independently distinguish different types of chronic liver diseases.3. The percentage of detected CK19 are higher in HCC patients than that in patients with other chronic liver diseases. Single serum CK19 has a low diagnostic accuracy of HCC, while the sensitivity and specificity will be raised when combined with AFP.