南方医科大学学报 ›› 2004, Vol. 24 ›› Issue (10): 1181-1183.

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慢性乙型肝炎肝组织学状态相关性无创指标分析

陈永鹏, 朱幼芙, 冯筱榕, 彭劼, 侯金林   

  1. 南方医科大学南方医院感染内科, 广东, 广州, 510515
  • 出版日期:2004-10-20 发布日期:2004-10-20
  • 基金资助:
    收稿日期:2004-2-6。
    作者简介:陈永鹏(1968- ),男,硕士,主治医师、讲师,电话:020-61641945,E-mail:cyp@fimmu.com

Evaluation of non-invasive indices for liver histology in patients with chronic hepatitis B

CHEN Yong-peng, ZHU You-fu, FENG Xiao-rong, PENG Jie, HOU Jin-lin   

  1. 南方医科大学南方医院感染内科, 广东, 广州, 510515
  • Online:2004-10-20 Published:2004-10-20

摘要: 目的 了解病人血液常规、血清生化指标与慢性乙型肝炎肝组织学状态相关性,探讨病人肝组织炎症及纤维化的相关性指标。方法 统计252例住院病人资料,对病人年龄、性别、血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、白蛋白、球蛋白、白蛋白/球蛋白(A/G)比值、胆红素、凝血酶原时间(PT)、凝血酶原活动度(PTA)、外周血白细胞(WBC)、血小板计数进行回顾性分析,并行相关统计学处理。结果 肝组织炎症与病人常规血液学检查指标有一定相关性(P<0.05),血清AST、胆红素及外周血WBC、血小板与肝脏炎症有显著相关性,但血清ALT、AST不能完全真实反映肝组织炎症程度;肝组织纤维化与血清ALT无关,与其他血液学指标有一定相关性(P<0.05),以血清AST、胆红素、外周血血小板及年龄为显著;血液PT、胆红素、血小板与年龄等指标为早期肝硬化显著相关性指标:灵敏度31.5%,特异度94.4%,阴性预告值83.3%,阳性预告值60.7%,准确率80.7%。结论 单次血清ALT、AST检查不足以真实反映肝组织炎症状态,血清AST、胆红素及血液WBC、血小板与肝组织炎症相关性显著;在肝纤维化分期中,血清AST、胆红素、外周血血小板及病人年龄有显著相关性,病人年龄、血小板、血清胆红素、PT对确认早期肝硬化有较高特异性,但不能作为筛选指标。

Abstract: Objective To assess the correlation of routine blood and serum biochemical indices with liver histology,and identify the sensitive non-invasive ones indicative of liver inflammation and fibrosis in patients with chronic hepatitis B.Methods A total of 252 patients were enrolled in this retrospective analysis. The indices including the patients’ age,gender,serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),albumin,globulin,total bilirubin,prothrombin time (PT) and its activity (PTA),WBC,and platelet count were analyzed statistically. Results The status of liver inflammation was correlated to patients’ routine blood indices (P<0.05). Serum AST,total bilirubin,WBC,and platelet count was related significantly to the degree of liver inflammation,but serum ALT and AST alone did not describe exactly the degree of liver inflammation. The status of liver fibrosis was independent of patients’ serum ALT,but correlated to other routine blood indices (P<0.05). The patients’ age,serum AST,total bilirubin and platelet count had significant relation to the stage of liver fibrosis,and the age,blood PT,total bilirubin and platelet count were significant relevant indices for early liver cirrhosis,and their sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 31.5%,94.4%,60.7%,83.3% and 80.7%,respectively.Conclusions Single examination of serum ALT and AST does not help much to predict the status of liver test in patients with chronic hepatitis B. Serum AST,total bilirubin,WBC and platelet count are associated with the degree of liver inflammation. The patients’ age,serum total bilirubin,AST and platelet count are relevant indices for liver fibrosis,and patients’age,serum total bilirubin,PT,and platelet count provide valuable assistance in confirmation of early liver cirrhosis with high specificity,but not so for screening purpose.

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