Caspase-cleaved fragments of cytokeratin-18 as a marker of inflammatory activity in chronic hepatitis B virus infection

Alternative Title
Bea Chang Bum
Alternative Author(s)
일반대학원 의학과
The Graduate School, Ajou University
Publication Year
만성 B형 간염 환자에서 염증반응 예측인자로서 Cytokeratin-18 분절의 유용성 목적: 만성 B형 간염 환자에서 비활동성 보균자와 활동성 간염환자를 구분하는 것은 치료 방향을 결정할 때 중요하다. 본 연구는 세포 자멸의 생물학적 표지자로 알려진 cytokeratin-18분절이 만성 B형 간염의 염증 반응 정도를 예측할 수 있는 지에 대해 조사하였다. 방법: 간 조직 검사를 시행한 만성 B형 간염 환자 총 339명 중에서 비활동성 보균자 36명, HBe항원 음성 간염 환자 80명, HBe항원 양성 간염 환자 141명, 간경화증 환자 82명을 대상으로 하였다. 결과: 혈청 M30 항원은 ALT, AST, 간 조직검사 결과와 통계학적으로 유의한 관계(p=0.000)를 나타냈고 간의 중요한 염증 반응을 나타내는 독립인자로 AST (p<0.001), M30 항원 (p=0.020), ALT (p=0.009)가 확인되었다. M30 항원과 AST를 함께 측정할 경우 특이도 96.1%, 양성 예측도 91.0%로 의미 있는 결과를 확인하였지만 비활동성 보균자와 HBe항원 음성 간염환자에서 M30 항원의 유의한 차이는 나타나지 않았다. 결론: Cytokeratin-18 분절 수치는 만성 B형 간염환자에서 간의 중요한 염증 반응과 관련이 있음을 확인하였다.
Alternative Abstract
Caspase-cleaved fragments of cytokeratin-18 as a marker of inflammatory activity in chronic hepatitis B virus infection Background: The differential diagnosis between inactive carrier and active hepatitis is important in patients with chronic hepatitis B (CHB) virus infection. Serum cytokeratin (CK)-18 fragments (M30 antigen) are proposed as biomarkers of apoptosis. We investigated whether serum M30 levels might help to characterize the various phases of CHB and predict the state of significant inflammation in patients with CHB. Methods: A total of 339 CHB patients who underwent liver biopsy, were included. Serum M30 antigen levels were compared with inactive carriers (n=36), patients with HBeAg- negative hepatitis (n=80), HBeAg-positive hepatitis (n=141) and liver cirrhosis (n=82). Results: Serum M30 antigen levels were correlated significantly not only with ALT (r=0.315, p<0.001) and AST (r=0.544, p<0.001), but also inflammatory grading score on liver biopsy (r=0.240, p<0.001). Multivariate analysis showed that AST (P<0.001), M30-antigen (P=0.020) and albumin (P=0.009) were the independent predictors of significant inflammation. The area under the curve of the receiver operating characteristic plot for the detection of significant inflammation of serum AST, M30-antigen and ALT levels were 0.872, 0.795 and 0.758 respectively. Combined serum M30 level (>344 U/L) and AST (>78 IU/L) measurements provided the most accurate identification of significant inflammation, showing 38.2% sensitivity, 96.1% specificity, 91.0% positive predictive value and 56.1% negative predictive value. We did not detect any significant differences in serum M30 levels between inactive HBV carrier and HBeAg-negative CHB. Conclusions: CK-18 fragment levels are correlated with liver inflammation and serum M30 levels are associated with the presence of significant inflammation in patients with CHB.

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Graduate School of Ajou University > Department of Medicine > 3. Theses(Master)
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