【摘要】 目的研究多项血清指标联合评分对乙型肝炎(乙肝)肝硬化的诊断价值。方法回顾性分析52例慢性乙型肝炎病毒感染患者的临床资料,以病理活检为依据,将肝病患者分为Ⅰ组(肝硬化组)和Ⅱ组(非肝硬化组)。以67例正常体检者为对照组(Ⅲ组)。比较各组谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白、总胆红素、总胆固醇、甘油三酯、α2-巨球蛋白、脂蛋白A1和γ转肽酶(GGT)的水平差异,并计算Ⅰ组肝纤维化分期的受试者工作特征曲线(ROC)下面积和肝纤维化指数积分。结果ALT、GGT、α2-巨球蛋白、总胆红素与肝纤维化分期存在显著相关性(P<0.05)。联合ALT、GGT、α2-巨球蛋白、总胆红素、脂蛋白A15种指标计算ROC面积为0.83±0.13。肝纤维化指数积分为0~0.2时具有很好的肝硬化阴性诊断价值(92.3%),积分为0.8~1.0时对肝硬化诊断的灵敏度为81.8%。结论联合ALT、GGT、α2-巨球蛋白、总胆红素、脂蛋白A对乙肝肝硬化可作出较准确临床诊断,可能会减少患者的肝穿刺活检的次数。更多还原

【Abstract】 Objective To in vestigate the value of serum biochemical markers in the diagnosis of liver fibro sis in patients with hepatitis B. Methods Fifty-two patients with hepatitis B v irus (HBV) infection were divided into liver fibrosis group (group Ⅰ) and non-l iver fibrosis group (group Ⅱ) according to the results of pathological biopsy, with 67 normal subjects serving as control (group Ⅲ). The levels of alanine am inotransterase (ALT), aspartate aminotransterase (AST), albumin, total bilirumin , total cholesterol, á 2-macrogbulin, apolipoprotient-A 1 (Apo-A 1 ) and ?-glutamyltranspeptidase (GGT) were compared among the 3 groups, and the area under the receiver operation characteristic (ROC) curve and liver fibro sis index scores were calculated for the patients with liver fibrosis at different stages. Results It was observed that the levels of ALT, tot al bilirumin, á 2-macrogbulin, APO-A 1 and GGT were significantly correlated with the clinical staging of liver fi brosis (P<0.05). ROC area calculated in connection with the 5 serum biochemical markers was 0.830, the accuracy reached 81.8%. Conclusion A combined assessment of the in-dices such as ALT, total bilirumin, á 2-macrogbulin, APO-A 1 and GGT may help obtain an accurate diagnosis of liver cirrhosis with less need of pathological biopsy.更多还原