【摘要】：目的:運(yùn)用受試者工作特征(receiver operating characteristic,ROC)曲線評價(jià)四種血清學(xué)指標(biāo)對乙型肝炎后肝纖維化的診斷效果,并探討其臨床意義。方法:選取本醫(yī)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例作為研究對象:其中100例為合并膽囊結(jié)石行膽囊切除患者,18例為合并門脈高壓癥行脾切除患者。所有患者于術(shù)中行肝活檢檢查,并根據(jù)Metavir評分系統(tǒng)分級,同時收集所有患者手術(shù)前一天的透明質(zhì)酸(hyaluronic acid,HA)、IV型膠原(IV-collagen,IV-C)、單胺氧化酶(monoamine oxidase,MAO)、轉(zhuǎn)化生長因子β1(transforming growth factorβ1,TGF-β1)的實(shí)驗(yàn)室檢查結(jié)果,分析四種指標(biāo)與肝纖維化程度的相關(guān)性,并建立ROC曲線評價(jià)各指標(biāo)單獨(dú)診斷和聯(lián)合診斷乙型肝炎后肝纖維化的價(jià)值。結(jié)果:全部118例患者手術(shù)過程均順利,術(shù)中術(shù)后無死亡病例。術(shù)中肝活檢結(jié)果顯示:F0期25例,F1期20例,F2期19例,F3期23例,F4期31例。肝纖維化分期與炎癥分級之間的相關(guān)系數(shù)=0.657,p=0.000,總體上肝纖維化的嚴(yán)重程度隨組織炎癥程度的加重而加重。分析不同肝纖維化分期的患者術(shù)前HA、IV-C、MAO、TGF-β1水平顯示,HA在F0~F4期患者的水平分別為:(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期患者的水平分別為:(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期患者的水平分別為:(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期患者的水平分別為:(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。將四種血清學(xué)指標(biāo)與肝纖維化分期進(jìn)行spearman相關(guān)性分析,結(jié)果顯示HA、IV-C、MAO、TGF-β1的水平與肝纖維化分期均呈正相關(guān),p0.05,有統(tǒng)計(jì)學(xué)意義。以1-特異度為橫坐標(biāo),靈敏度為縱坐標(biāo)繪制ROC曲線,結(jié)果顯示對診斷顯著肝纖維化HA、IV-C、MAO、TGF-β1的曲線下面積(area under curve,AUC)分別為:0.64、0.72、0.76、0.80,當(dāng)四種指標(biāo)聯(lián)合診斷時,其AUC可達(dá)0.83。而診斷肝硬化時HA、IV-C、MAO、TGF-β1的AUC分別為:0.69、0.73、0.82、0.80,當(dāng)四種指標(biāo)聯(lián)合診斷時,其AUC可達(dá)0.83。結(jié)論:1.四種血清學(xué)指標(biāo)與慢性乙型肝炎后肝纖維化的病理分期均顯示了良好的相關(guān)性,其中TGF-β1的相關(guān)性最高;在診斷顯著肝纖維化(F≥2)時TGF-β1的價(jià)值最高,在診斷肝硬化(F=4)時MAO的價(jià)值最高。2.四種指標(biāo)聯(lián)合應(yīng)用對診斷肝纖維化的效果較好,優(yōu)于單一指標(biāo),可作為一種簡便、無創(chuàng)、高效的診斷乙肝后肝纖維化的方法。
[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緇村寲鍒嗘湡鐨勬?zhèn)ｈ�呮湳鍓岺A,IV-C,MAO,TGF-尾1姘村鉤鏄劇ず,HA鍦‵0~F4鏈熸?zhèn)ｈ�呯殑姘村鉤鍒嗗埆涓，

本文編號：2232032