ROC曲线法评价血清蛋白电泳诊断乙型肝炎相关肝硬化的价值  

Appraisement of serum protein electrophoreses for diagnosis of hepatitis B associated cirrhosis by ROC curve method

作　　者：张占卿[1] 陆伟[1] 王雁冰[1] 饶敏[1] 陈淑琴[1] 冯艳玲[2] 周毅[3] 

机构地区：[1]上海市公共卫生临床中心肝炎二科,201508 [2]上海市公共卫生临床中心病理科,201508 [3]上海市公共卫生临床中心检验科,201508

出　　处：《中华临床医师杂志（电子版）》2011年第12期3459-3463,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市科委科技计划项目(09411965800)

摘　　要：目的探讨血清蛋白电泳(SPE)各组分含量构成比诊断乙型肝炎相关肝硬化的价值。方法慢性乙型肝炎219例,其中病理学诊断为肝硬化和非肝硬化的患者分别为51例和168例;SPE各组分含量构成比采用法国Sebia公司生产的Hydrasys全自动电泳仪及其配套试剂检测。SPE各组分含量构成比之间的比较采用两独立样本的t检验;SPE各组分含量构成比诊断肝硬化的评价采用ROC曲线法,SPE各组分含量构成比诊断肝硬化的ROC曲线下面积之间的相互比较采用U检验。结果肝硬化血清白蛋白、α2-球蛋白、β-球蛋白含量构成比显著低于非肝硬化(P<0.05),血清α1-球蛋白、γ-球蛋白含量构成比显著高于非肝硬化(P<0.05)。SPE各组分含量构成比诊断肝硬化的ROC曲线下面积均显著大于标准参考线下面积,其中血清白蛋白和γ-球蛋白含量构成比诊断肝硬化的ROC曲线下面积分别为0.796和0.840。血清白蛋白、γ-球蛋白含量构成比诊断肝硬化的ROC曲线下面积之间差异无统计学意义(P>0.05),血清α1-球蛋白、α2-球蛋白、β-球蛋白含量构成比诊断肝硬化的ROC曲线下面积之间差异无统计学意义(P>0.05),血清白蛋白、γ-球蛋白含量构成比诊断肝硬化的ROC曲线下面积均显著大于α1-球蛋白、α2-球蛋白、β-球蛋白含量构成比诊断肝硬化的ROC曲线下面积(P<0.05)。血清白蛋白和γ-球蛋白含量构成比诊断肝硬化的最佳截断值分别为≤62.00%和≥17.55%,其对应的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为0.647和0.824、0.833和0.738、0.541和0.488、0.886和0.932、0.789和0.758。结论基于SPE的血清白蛋白和γ-球蛋白含量构成比用于诊断乙型肝炎相关肝硬化既经济又实用,可作为肝硬化无创诊断的两项重要参考指标。Objective To explore the efficacy of proportions of fractions of serum protein electrophoreses for diagnosis of hepatitis B associated cirrhosis.Methods 219 consecutive patients with chronic hepatitis B were studied,in which 51 patients and 168 patients were pathologically diagnosed as cirrhosis and non-cirrhosis respectively.The proportions of fractions of serum protein electrophoreses were measured by fully-automated Hydrasys and auxiliary reagents(Sebia Electrophoresis,France).SPSS 13.0 software was used for statistical analyses.Independent samples t test was used for comparison of the proportions of fractions of serum protein electrophoreses between cirrhosis and non-cirrhosis;ROC curves were plotted for appraisement of proportions of fractions of serum protein electrophoreses for diagnosis of cirrhosis,U test was used for comparison of the areas under ROC curve between the proportions of each fractions of serum protein electrophoreses for diagnosis of cirrhosis.Results The proportions of serum albumin,α2-globulin,β-globulin in patients with cirrhosis were significantly lower than those in patients with non-cirrhosis(P<0.05);and the proportions of serum α1-globulin,γ-globulin in patients with cirrhosis were significantly higher than those in patients with non-cirrhosis(P<0.05).The areas under ROC curve of the proportions of each fractions of serum protein electrophoreses for diagnosis of cirrhosis were all larger significantly than the area under reference line,in which the areas under ROC curve of the proportions of serum albumin and γ-globulin for diagnosis of cirrhosis were 0.796 and 0.840 respectively.There was no significant difference between the areas under ROC curve of the proportions of serum albumin and γ-globulin for diagnosis of cirrhosis(P>0.05);There was no significant difference between those of the proportions of serum α1-globulin,α2-globulin,β-globulin for diagnosis of cirrhosis(P>0.05).The areas under ROC curve of the proportions of serum albumin and γ-globulin were both larger sig

关 键 词：肝炎 乙型 肝硬化 血蛋白电泳 ROC曲线 无创诊断 

分 类 号：R575.2[医药卫生—消化系统]