目的 探讨血清高尔基体跨膜糖蛋白73（GP73）、壳多糖酶3样蛋白1（CHI3L1）水平变化与慢性乙型肝炎（CHB）患者肝纤维化及病变程度的关系。 方法 采用病例对照研究，选取长沙市第一医院感染科2020年6月至2023年6月确诊的80例CHB感染且发生肝纤维化患者作为肝纤维化组，感染科门诊既往确诊的CHB感染但未发生肝纤维的患者120例作为对照组，对比两组患者的血清GP3、CHI3L1、肝功能、纤维化指标，并根据Scheuer系统标准将肝纤维化组患者分为轻度、显著肝纤维化患者进行分层分析。 结果 肝纤维化组患者血清GP3、CHI3L1水平显著高于对照组，差异有统计学意义（P < 0.05）；以血清GP3、CHI3L1、GP3 + CHI3L1分别绘制ROC曲线，其诊断CHB患者发生肝纤维化的灵敏度为：62.81%、60.94%、96.33%，特异度为：80.66%、80.05%、75.30%，曲线下面积AUC值分别为：0.792、0.756、0.908；肝纤维化组患者的ALT、AST、HA、LN、PCⅢNP、CⅣ、CG水平均高于对照组，PLT测定值低于对照组，差异有统计学意义（P < 0.05）；中重度肝纤维化患者49例（S2期33例、S3期16例）、轻度肝纤维化患者31例（均为S1期），中重度肝纤维化患者血清GP3、CHI3L1水平显著高于轻度患者，差异有统计学意义（P < 0.05）；中重度肝纤维化患者的DBIL、ALT、AST、HA、LN、PCⅢNP、CⅣ、CG水平均高于轻度组，PLT测定值低于轻度组，差异有统计学意义（P < 0.05）。 结论 CHB肝纤维化患者的血清GP3、CHI3L1水平显著升高，并且与肝纤维化程度有一定的相关性，两项指标结合应用有利于诊断CHB患者发生肝纤维化。

Objective Exploring the relationship between changes in serum Golgi apparatus transmembrane glycoprotein 73 （GP73） and chitosanase 3-like protein 1 （CHI3L1） levels and liver fibrosis and lesion severity in patients with hepatitis B （CHB）. Methods Using a case-control study， 80 patients diagnosed with CHB infection and developing liver fibrosis in the Infectious Disease Department of Changsha First Hospital from June 2020 to June 2023 were selected as the liver fibrosis group， while 120 patients diagnosed with CHB infection but not developing liver fibrosis in the Infectious Disease Department of our hospital were selected as the control group. The serum GP3， CHI3L1， liver function， and fibrosis indicators of the two groups of patients were compared， and the liver fibrosis group was divided into mild according to Scheuer system standards Perform stratified analysis on patients with significant liver fibrosis. Results The serum GP3 and CHI3L1 levels in the liver fibrosis group were significantly higher than those in the control group， with statistical significance （P < 0.05）； The ROC curves were plotted using serum GP3， CHI3L1， and GP3 + CHI3L1， respectively. The sensitivity for diagnosing liver fibrosis in CHB patients was 62.81%， 60.94%， and 96.33%， with specificity of 80.66%， 80.05%， and 75.30%. The AUC values under the curves were 0.792， 0.756， and 0.908， respectively； The levels of ALT， AST， HA， LN， PC III NP， C IV， and CG in the liver fibrosis group were higher than those in the control group， and the PLT measurement values were lower than those in the control group， with statistical significance （P < 0.05）； 49 patients with moderate to severe liver fibrosis （33 in S2 phase and 16 in S3 phase） and 31 patients with mild liver fibrosis （all in S1 phase） had significantly higher serum GP3 and CHI3L1 levels than mild patients， with statistical significance （P < 0.05）； The levels of DBIL， ALT， AST， HA， LN， PC III NP， C IV， and CG in patients with moderate to severe liver fibrosis were higher than those in the mild group， and the PLT measurement values were lower than those in the mild group， with statistical significance （P < 0.05）. Conclusion The serum GP3 and CHI3L1 levels in CHB patients with liver fibrosis are significantly elevated， and there is a certain correlation with the degree of liver fibrosis. The combination of these two indicators is beneficial for diagnosing liver fibrosis in CHB patients.