Objective: To study the changes of serum N-glycan abundance in patients with liver fibrosis at different stages of hepatitis C, and to establish and evaluate the diagnostic model for clinical application value. Methods: Data of 169 hepatitis C virus-infected cases with liver fibrosis were enrolled. Nine kinds of serum N-glycans were detected and analyzed using DNA sequencer-assisted fluorophore-assisted capillary electrophoresis technology. A binary logistics regression method was used to establish a diagnostic model based on the changes in the relative content of N-glycans in each stage of liver fibrosis. Receiver operating characteristic curve was used to evaluate and compare the diagnostic efficacy with other liver fibrosis diagnostic models. Results: N-glycan diagnostic model (B and C) had highest AUROC= 0.776, 0.827 for distinguishing fibrosis S1~S2 to S3~S4 and S1~S3 to S4 than GlycoFibroTest (AUROC = 0.760, 0.807), GlycoCirrhoTest (AUROC = 0.722, 0.787), aspartate aminotransferase to platelet ratio index (AUROC = 0.755, 0.751), FIB-4 index (AUROC = 0.730, 0.774), and S-index (AUROC = 0.707, 0.744). However, the diagnostic efficacy of model A (AUROC = 0.752) for distinguishing fibrosis S1 with S2~S4 had lower diagnostic potency than that of the aspartate aminotransferase to platelet ratio index (AUROC = 0.807). Diagnostic efficiency was improved when the N-glycan profiling and the aspartate aminotransferase to platelet ratio index were combined to diagnose liver fibrosis in each stage, and the area under the receiver operating characteristic curve was 0.839, 0.825, and 0.837, respectively. Conclusion: The serum N-glycan profiling diagnostic model has potential clinical application value in the diagnosis of liver fibrosis in patients with hepatitis C.
目的： 研究丙型肝炎不同分期肝纤维化患者血清中N-聚糖丰度变化，依此建立丙型肝炎肝纤维化诊断N-糖组模型并评估其临床应用价值。 方法： 纳入169例丙型肝炎肝纤维化患者资料，采用基于DNA测序仪的荧光标记糖电泳技术，检测和分析患者血清中9种N-聚糖。基于肝纤维化各期N-聚糖相对含量变化，应用二元Logistics回归方法建立诊断模型，采用受试者操作特征曲线等评价其诊断效力，并与其他肝纤维化诊断模型比较。 结果： N-糖组诊断模型（模型B和模型C）在区分纤维化S1～S2与S3～S4和S1～S3与S4受试者操作特征曲线下面积最大（受试者操作特征曲线下面积= 0.776，0.827），高于GlycoFibroTest （受试者操作特征曲线下面积= 0.760,0.807）、GlycoCirrhoTest（受试者操作特征曲线下面积= 0.722，0.787）、天冬氨酸转氨酶与血小板的比值指数（受试者操作特征曲线下面积= 0.755，0.751）、肝纤维化4项指数（受试者操作特征曲线下面积= 0.730，0.774）和S指数（受试者操作特征曲线下面积= 0.707,0.744），但模型A（受试者操作特征曲线下面积= 0.752）在区分纤维化S1与S2～S4时诊断效力仅低于天冬氨酸转氨酶与血小板的比值指数（受试者操作特征曲线下面积= 0.807）。当N-糖组模型与天冬氨酸转氨酶与血小板的比值指数联合诊断各期肝纤维化时，受试者工作特征曲线下面积（模型A、模型B和模型C）为0.839、0.825和0.837，提高了诊断效力。 结论： 血清N-糖组模型诊断丙型肝炎肝纤维化具有潜在临床应用价值。.
Keywords: Diagnostic models; Hepatitis C, chronic; Liver cirrhosis; N-glycome.