Objective To explore the diagnostic value of noninvasive target S index in combination with serum hyaluronic acid (HA) in the diagnosis of liver fibrosis in chronic hepatitis B (CHB). Methods liver biopsy staging was performed in 76 patients with CHB, by referring to relevant literatures, the S index consisted of GGT,PLT and albumin(Alb) [S index = 1000 ×GGT/(PLT× Alb2) ] ,serum HA was determined by RIA. Results Using S index (0.1 for negative tolerances, 0.5 for positive tolerances)as the index of eliminating and diagnosing significant liver fibrosis, the need for liver biopsy would reduce by 44.7%(34/76) with an accuracy rate of 73.5% (25/34) ;42 patients unidentified by S index were assessed by serum HA, the need for liver biopsy would reduce by 57.1% (24/42) with an accuracy rate of 79.2% (19/24) ;Combining S index and serum HA, the need for liver biopsy would reduce by 76.3% (58/76) with an accuracy rate of 75.9% (44/58). Conclusion A combination and dynamic monitoring of S index and serum HA improves the diagnostic performance for liver fibrosis in CHB patients and reduce or avoid the liver biopsy.%目的:探讨慢性乙型肝炎(CHB)肝纤维化非侵袭性诊断指标S指数与血清透明质酸(HA)联合应用的临床诊断价值.方法:对76例CHB患者行肝活检分期,参照有关文献通过γ﹣谷氨酰转肽酶(GGT)、血小板(PLT)和白蛋白(Alb)三个常规项目计算S指数[S指数=1000×GGT/(PLT×Alb2)],同时应用放射免疫分析测定血清HA.结果:单用S指数(以0.1为阴性界值,0.5为阳性界值)作为排除和诊断显著肝纤维化的指标,可避免44.7%(34/76)的肝活检,其准确率为73.5%(25/34);用HA对未被S指数确定的42例患者进行再评价,又可避免57.1%(24/42)的肝活检,其准确率为79.2%(19/24);将S指数与血清HA进行联合应用,则可避免76.3%(58/76)的肝活检,其准确率为75.9%(44/58).结论:S指数与血清HA的联合应用及动态监测可提高无创评估CHB肝纤维化的诊断效率,减少或避免肝活检.
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