四种血清学指标对乙肝后肝纤维化的诊断效果研究

发布时间：2018-09-09 09:49

【摘要】：目的:运用受试者工作特征(receiver operating characteristic,ROC)曲线评价四种血清学指标对乙型肝炎后肝纤维化的诊断效果,并探讨其临床意义。方法:选取本医院普外科2015年4月至2016年11月收治的慢性乙型肝炎患者118例作为研究对象:其中100例为合并胆囊结石行胆囊切除患者,18例为合并门脉高压症行脾切除患者。所有患者于术中行肝活检检查,并根据Metavir评分系统分级,同时收集所有患者手术前一天的透明质酸(hyaluronic acid,HA)、IV型胶原(IV-collagen,IV-C)、单胺氧化酶(monoamine oxidase,MAO)、转化生长因子β1(transforming growth factorβ1,TGF-β1)的实验室检查结果,分析四种指标与肝纤维化程度的相关性,并建立ROC曲线评价各指标单独诊断和联合诊断乙型肝炎后肝纤维化的价值。结果:全部118例患者手术过程均顺利,术中术后无死亡病例。术中肝活检结果显示:F0期25例,F1期20例,F2期19例,F3期23例,F4期31例。肝纤维化分期与炎症分级之间的相关系数=0.657,p=0.000,总体上肝纤维化的严重程度随组织炎症程度的加重而加重。分析不同肝纤维化分期的患者术前HA、IV-C、MAO、TGF-β1水平显示,HA在F0~F4期患者的水平分别为:(70.81±37.73)ng/ml,(91.62±39.08)ng/ml,(70±36.22)ng/ml,(91.98±40.88)ng/ml,(111.85±49.27)ng/ml;IV-C在F0~F4期患者的水平分别为:(68.60±35.30)ng/ml,(85.32±41.81)ng/ml,(103.82±43.76)ng/ml(102.83±54.39)ng/ml,(133.53±60.92)ng/ml;MAO在F0~F4期患者的水平分别为:(12.79±6.44)U/L,(15.42±6.56)U/L,(18.54±7.15)U/L,(17.62±8.92)U/L,(25.50±8.37)U/L;TGF-β1在F0~F4期患者的水平分别为:(12.79±6.44)ng/ml,(15.42±6.56)ng/ml,(18.54±7.15)ng/ml,(17.62±8.92)ng/ml,(25.50±8.37)ng/ml。将四种血清学指标与肝纤维化分期进行spearman相关性分析,结果显示HA、IV-C、MAO、TGF-β1的水平与肝纤维化分期均呈正相关,p0.05,有统计学意义。以1-特异度为横坐标,灵敏度为纵坐标绘制ROC曲线,结果显示对诊断显著肝纤维化HA、IV-C、MAO、TGF-β1的曲线下面积(area under curve,AUC)分别为:0.64、0.72、0.76、0.80,当四种指标联合诊断时,其AUC可达0.83。而诊断肝硬化时HA、IV-C、MAO、TGF-β1的AUC分别为:0.69、0.73、0.82、0.80,当四种指标联合诊断时,其AUC可达0.83。结论:1.四种血清学指标与慢性乙型肝炎后肝纤维化的病理分期均显示了良好的相关性,其中TGF-β1的相关性最高;在诊断显著肝纤维化(F≥2)时TGF-β1的价值最高,在诊断肝硬化(F=4)时MAO的价值最高。2.四种指标联合应用对诊断肝纤维化的效果较好,优于单一指标,可作为一种简便、无创、高效的诊断乙肝后肝纤维化的方法。
[Abstract]:Objective: to evaluate the diagnostic effect of four serological indexes on hepatic fibrosis after hepatitis B by using the (receiver operating characteristic,ROC curve and to explore its clinical significance. Methods: from April 2015 to November 2016, 118 patients with chronic hepatitis B were selected from general surgery department of our hospital. Among them, 100 cases were complicated with gallstone cholecystectomy and 18 cases were splenectomy with portal hypertension. All patients were examined by liver biopsy during operation, and the results of laboratory examination of hyaluronic acid (hyaluronic acid,HA) type IV collagen (IV-collagen,IV-C), monoamine oxidase (monoamine oxidase,MAO) and transforming growth factor 尾 1 (TGF- 尾 1) were collected one day before operation according to the Metavir scoring system. The correlation between the four indexes and the degree of hepatic fibrosis was analyzed, and the ROC curve was established to evaluate the value of each index in the diagnosis of liver fibrosis after hepatitis B. Results: all 118 patients underwent smooth operation, and there were no death cases after operation. Intraoperative liver biopsy showed 25 cases of stage F _ 0 and 20 cases of F _ 1 stage, 19 cases of F _ 3 stage, 23 cases of F _ 3 stage and 31 cases of F _ 4 stage. The correlation coefficient between the stage of hepatic fibrosis and the grade of inflammation was 0.657%, and the severity of hepatic fibrosis increased with the severity of inflammation. 鍒嗘瀽涓嶅悓鑲濈氦缁村寲鍒嗘湡鐨勬偅鑰呮湳鍓岺A,IV-C,MAO,TGF-尾1姘村钩鏄剧ず,HA鍦‵0~F4鏈熸偅鑰呯殑姘村钩鍒嗗埆涓，

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