| Objective To explore the value of combined detection of serum levels of chitinase-3-like protein 1 (CHI3L1) and growth differentiation factor 15 (GDF-15) in the early diagnosis of hepatitis B virus (HBV)-related primary liver cancer.Methods This retro-spective study included 103 patients with HBV-related primary liver cancer (primary liver cancer group), 96 patients with liver fibrosis(liver fibrosis group), 99 patients with cirrhosis (liver cirrhosis group), 105 patients with chronic hepatitis (chronic hepatitis group), and100 healthy individuals (health control group) admitted to Yuncheng Central Hospital of Shanxi Province from January 2021 to June2023. Enzyme-linked immunosorbent assay (ELISA) was used to detect and compare serum levels of CHI3L1, GDF15, alpha-fetopro-tein (AFP) and protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) across the groups. Serum levels of CHI3L1 andGDF15 in patients with primary liver cancer with different pathological characteristics were compared. Receiver operating characteris-tic (ROC) curve analysis was conducted to evaluate the diagnostic value of serum CHI3L1 and GDF15 levels alone and in combination,as well as the combined detection of all four biomarkers for early diagnosis of HBV-related primary liver cancer.Results Compared tothe healthy control group [(45.17±5.69) μg/L, (372.43±40.76) ng/L, (33.08±4.69) μg/L, (362.52±38.72) AU/L], serum levels ofCHI3L1, GDF15, AFP, and PIVKA-Ⅱ were significantly elevated in the chronic hepatitis group [(49.64±6.32) μg/L, (401.65±43.84)ng/L, (36.16±4.85) μg/L, (385.74±41.26) AU/L], cirrhosis group [(54.83±7.86) μg/L, (437.83±47.96) ng/L, (39.43±5.13) μg/L,(408.81±43.85) AU/L], liver fibrosis group [(60.35±8.13) μg/L, (462.79±51.62) ng/L, (42.26±5.38) μg/L, (433.63±47.23) AU/L], andprimary liver cancer group [(67.58±8.61) μg/L, (499.62±53.91) ng/L, (45.58±6.21) μg/L, (458.69±49.28) AU/L] (all P<0.05). SerumCHI3L1 and GDF15 levels were significantly higher in patients with multiple tumors, tumor length≥5 cm, TNM stage Ⅱ to Ⅳ, portalvein tumor thrombi, distant metastasis, cirrhosis, low differentiation, Child-Pugh liver function grade B, and incomplete tumor capsule than in those with single tumor, tumor length<5 cm, TNM stage Ⅰ-Ⅱ, no portal vein tumor thrombus, no distant metastasis, no cirrho-sis, moderate to high differentiation, Child-Pugh liver function grade A, and intact tumor capsule (all P<0.05). The AUC values for se-rum CHI3L1, GDF15, AFP, PIVKA-Ⅱ alone and in combination were 0.79, 0.79, 0.86, 0.83, 0.82, 0.90, and 0.96, respectively. TheAUC for combined CHI3L1 and GDF15 was significantly higher than that for either biomarker alone (both P<0.05). Similarly, the com-bined AUC for AFP and PIVKA-Ⅱ was significantly higher than that for either marker alone (both P<0.05). The combined prediction AUC of all four biomarkers (CHI3L1, GDF15, AFP, and PIVKA-Ⅱ) was also significantly higher than that of individual biomarkers (all P<0.05).Conclusions Serum levels of CHI3L1 and GDF15 are highly expressed in patients with HBV-related primary liver cancer. Both alone and in combination, they have important reference value for early diagnosis of HBV-related primary liver cancer. |
