探讨血清白蛋白和球蛋白对乙型肝炎相关肝硬化的诊断价值

摘要

目的：对血清白蛋白、球蛋白以及两者比值对乙型肝炎相关肝硬化诊断价值进行探讨。方法选择2013年1月-2014年12月至我院进行慢性乙型肝炎治疗的住院患者共计163例。其中经过病理诊断为肝硬化患者31例做为肝硬化组，非肝硬化患者132例做为非肝硬化组。患者入院后空腹取患者静脉血进行生化检查，记录每位患者的ALB、GLB、A／G 的数值。观察肝硬化组与非肝硬化组的上述数值是否有统计学差异。所有患者以肝脏穿刺的方法取1s 肝脏组织进行活检。使用血清 ALB、GLB、A／G 数值建立诊断肝硬化的 ROC 曲线，根据曲线确定诊断肝硬化的最佳截断值，通过最佳截断值计算诊断肝硬化的准确度、特异度、灵敏度、阴性预测值、阳性预测值、Youden 指数。结果与非肝硬化组相比较，肝硬化组的 ALB 明显降低，GLB 明显升高，A／G 明显降低，各组数据均有统计学差异（P＜0．05）。根据血清 ALB、GLB、A／G 数值建立肝硬化诊断 ROC 曲线，根据曲线确定血清 ALB、GLB、A／G 数值对于肝硬化诊断的最佳截断值分别为40．42 g／L、34．88 g／L、0．94。在此截断值范围内计算3组参数对于肝硬化诊断的灵敏度、特异度、阳性预测值、阴性预测值、准确度以及 Youden 指数。结论血清白蛋白、球蛋白以及两者比值均可成为乙型肝炎相关肝硬化的诊断指标，且具有较强的实用性。%Objective To discuss the clinical value of serum albumin globulin and their ratio for hepatitis b associat-ed cirrhosis of the liver.Methods 163 cases with chronic hepatitis B,which admitted in our hospital during January 2013-December 2014.There were 31 patients by pathological diagnosis of cirrhosis of the liver set as the cirrhosis group the other 132 cases were set as non-cirrhosis group.Patients after admission were given venous blood biochemical examination on an empty stomach,the value of ALB GLB A/G were recorded.Weather the above numerical statistically significant was compared.1s liver tissue biopsy was taken by liver puncture method.The ROC curve of diagnosis cirrho-sis of the liver was built by the value of ALB GLB A/G.Determine the optimal cutoff value of diagnosis of cirrhosis of the liver by the curve and calculated the accuracy of diagnosis of liver cirrhosis,specific degrees,sensitivity,negative predictive value,positive predictive value,Youden index by the cutoff value.Results Compared with the liver non-cir-rhosis group,ALB of liver cirrhosis group was obviously lower,GLB increased significantly,A/G was decreased obvi-ously,data of each groups were statistically significant.According to the ALB GLB A/G value,the ROC curve of diag-nosis cirrhosis of the liver was built.According to the curve to determine the serum values ALB GLB A/G for the opti-mal cutoff value of diagnosis of cirrhosis 40.42 g/L,34.88 g/L,0.94.Within the scope of the cutoff value calculation of three groups of parameters for cirrhosis diagnosis sensitivity,specific,positive predictive value,negative predictive val-ue,accuracy and Youden index.Conclusion Serum albumin,globulin and the ratio can be related to hepatitis b cirrhosis diagnosis index,and has strong practicability.