Changes in serum CHI3L1 levels in patients with Hp positive peptic ulcer and their clinical significance
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摘要: 目的 观察Hp阳性消化性溃疡患者血清壳多糖酶3样蛋白1(chitosanase 3-like protein 1，CHI3L1)水平的变化，分析其临床意义。方法 选择本院消化内科2020年2月—2023年2月期间收治的136例消化性溃疡患者为研究对象，其中Hp阳性87例(Hp阳性组)、Hp阴性49例(Hp阴性组)，并将Hp阳性组分为Hp感染Ⅰ型(59例)、Hp感染Ⅱ型(28例)。比较Hp阳性组、Hp阴性组的年龄、性别、病情程度、吸烟史、饮酒史、饮食习惯、血清CHI3L1、转化生长因子-β1(transforming growth factor-β1，TGF-β1)、胃蛋白酶原(pepsinogen，PG)Ⅰ、PGⅡ等资料，并比较Hp阳性组不同病变部位、Hp感染类型、病情分期患者血清CHI3L1水平。分析消化性溃疡Hp感染的相关因素及血清CHI3L1水平对消化性溃疡Hp感染的诊断价值。结果 Hp阳性组血清CHI3L1、TGF-β1、PGⅠ、PGⅡ水平均高于Hp阴性组(P＜0.01)；Hp感染Ⅰ型患者血清CHI3L1水平高于Hp感染Ⅱ型患者(P＜0.01)；复合溃疡患者血清CHI3L1水平高于胃溃疡和十二指肠溃疡患者(P＜0.01)；活动期患者血清CHI3L1水平高于愈合期和瘢痕期(P＜0.01)，愈合期高于瘢痕期(P＜0.01)。多因素logistic回归分析发现血清CHI3L1、TGF-β1、PGⅠ、PGⅡ水平均为消化性溃疡患者合并Hp感染的独立危险因素；ROC曲线分析显示，CHI3L1诊断消化性溃疡患者Hp感染的最佳截断值为96.22 ng/mL，灵敏度、特异度分别为79.82%、86.11%，曲线下面积为0.902。结论 Hp阳性消化性溃疡患者血清CHI3L1水平升高，CHI3L1是消化性溃疡Hp感染的独立危险因素，与Hp感染类型、溃疡部位和疾病严重程度密切相关，在消化性溃疡Hp感染诊断中具有较高的临床价值。Abstract: Objective To observe the changes in serum chitosanase 3-like protein 1(CHI3L1) levels in patients with Helicobacter pylori(Hp) positive peptic ulcer and analyze its clinical significance.Methods One hundred and thirty-six patients with peptic ulcers admitted to the Department of Gastroenterology in our hospital from February, 2020 to February, 2023 were selected, including 87 Hp positive cases(Hp positive group) and 49 Hp negative cases(Hp negative group). The Hp positive group was divided into Hp infection type Ⅰ(59 cases) and Hp infection typeⅡ(28 cases). The age, gender, severity of illness, smoking history, drinking history, dietary habits, serum CHI3L1, transforming growth factor-β1(TGF-β1), pepsinogen(PG)Ⅰand PGⅡ. etc and general and clinical data were compared between the Hp positive and Hp negative groups. And the different lesion sites, Hp infection types, serum CHI3L1 levels in patients with stage of illness were compared in the Hp positive group. The relevant factors of Hp infection in peptic ulcers was analyzed, and the diagnostic value of serum CHI3L1 level for Hp infection in peptic ulcers.Results The levels of serum CHI3L1, TGF-β1, PGⅠand PGⅡ of the Hp positive group were higher than those of the Hp negative group(P < 0.01); the serum CHI3L1 level in patients with Hp infection type Ⅰwas higher than that in patients with Hp infection typeⅡ(P < 0.01); the serum CHI3L1 levels in patients with compound ulcers were higher than those in patients with gastric and duodenal ulcers(P < 0.01); the serum CHI3L1 levels in patients during the active phase were higher than those in the healing and scar phases(P < 0.01), and those in the healing phase were higher than those in the scar phase(P < 0.01). Multivariate logistic regression analysis found the levels of serum CHI3L1 and TGF-β1, PGⅠand PGⅡ were independent risk factors for peptic ulcer patients complicated with Hp infection; receiver operating characteristic analysis showed that the best cut-off value of CHI3L1 for diagnosing Hp infection in patients with peptic ulcer was 96.22 ng/mL, the sensitivity and specificity were 79.82% and 86.11% respectively, and the area under the curve was 0.902.Conclusion The serum CHI3L1 level is elevated in patients with Hp positive peptic ulcer, and CHI3L1 is an independent risk factor for Hp infection in peptic ulcer. It is closely related to the type of Hp infection, ulcer site, and disease severity, and it has a high clinical value in the diagnosis of Hp infection in peptic ulcer.
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Key words:
- Helicobacter pylori /
- peptic ulcer /
- chitosanase 3-like protein 1 /
- pepsinogen
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表 1 Hp阳性组和Hp阴性组患者的临床资料比较
例，X±S 临床资料 Hp阳性组(n=87) Hp阴性组(n=49) t/χ2 P 性别 0.355 0.551 男 49 25 女 38 24 年龄/岁 50.97±10.66 50.04±10.73 0.487 0.627 BMI 22.90±2.34 23.08±2.29 0.434 0.665 溃疡部位 1.477 0.478 胃溃疡 45 22 十二指肠溃疡 28 15 复合溃疡 14 12 溃疡直径/cm 2.11±0.47 1.98±0.42 1.608 0.110 吸烟 22 16 0.845 0.358 饮酒 31 20 0.359 0.549 辛辣饮食 27 17 0.192 0.661 暴饮暴食 24 16 0.388 0.534 进食习惯 0.113 0.737 共餐 61 33 分餐 26 16 TGF-β1/(ng/mL) 218.34±24.31 179.59±18.46 9.689 ＜0.001 PGⅠ/(ng/mL) 358.29±47.33 224.06±25.40 18.397 ＜0.001 PGⅡ/(ng/mL) 50.31±9.24 25.84±6.26 16.513 ＜0.001 CHI3L1/(ng/mL) 97.57±11.25 62.35±8.19 19.220 ＜0.001 
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表 2 Hp阳性组不同病理特征患者血清CHI3L1水平的比较
ng/mL，X±S 病理特征 例数 CHI3L1 t/F P Hp感染类型 11.266 ＜0.001 Ⅰ型 59 109.47±12.90 Ⅱ型 28 78.73±9.36 溃疡部位 156.881 ＜0.001 胃溃疡 45 67.81±8.42 十二指肠溃疡 28 71.56±8.76 复合溃疡 14 116.39±11.78 病情分期 109.024 ＜0.001 活动期 53 107.48±11.08 愈合期 22 85.37±9.29 瘢痕期 12 62.35±7.88
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表 3 消化性溃疡患者Hp感染多因素logistic回归分析
因素 β SE Wald χ2 P OR 95%CI TGF-β1 0.498 0.262 9.986 ＜0.001 1.436 1.161~6.702 PGⅠ 0.688 0.196 6.370 0.008 1.710 1.102~8.562 PGⅡ 0.679 0.180 5.448 0.011 1.867 1.022~9.605 CHI3L1 0.809 0.218 9.353 ＜0.001 2.273 1.636~14.236
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