血清补体C3和C4在预测慢性乙型肝炎肝纤维化程度中的价值  

serum complement c3 and c4 levels for predicting severity of hepatic fibrosis in patients with chronic hepatitis b

作　　者：张占卿[1] 陆伟[1] 王雁冰[1] 饶敏[1] 冯洁[1] 冯艳玲[2] 沈芳[3] 

机构地区：[1]201508,上海市公共卫生临床中心肝病二科 [2]201508,上海市公共卫生临床中心病理科 [3]201508,上海市公共卫生临床中心检验科

出　　处：《中华临床感染病杂志》2011年第5期-,共4页Chinese Journal of Clinical Infectious Diseases

基　　金：国家863计划生物和医药技术领域重大/重点项目基金，上海市科委科技计划项目

摘　　要：目的 探讨血清补体c3和c4预测慢性乙型肝炎肝纤维化程度的价值.方法 选择442例经肝组织病理学检查的慢性乙型肝炎患者.血清补体c3和c4采用beckman-coulter immage 800免疫化学系统及其配套试剂测定.血清补体c3和c4预测肝纤维化程度的评价采用roc曲线法.结果 血清补体c3和c4预测显著肝纤维化(≥s2)、严重肝纤维化(≥s3)、肝硬化(s4)的roc 曲线下面积均显著大于标准参考线下面积(p =0.009、0.000、0.000和p=0.005、0.000、0.000).根据roc曲线,血清补体c3预测严重肝纤维化和肝硬化的最佳截断值分别为≤0.74 g/l和≤0.64 g/l,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0.585、0.681、0.617、0.650、0.636和0.509、0.775、0.423、0.830、0.710；血清补体c4预测严重肝纤维化和肝硬化的最佳截断值分别为≤0.14 g/l和≤0.12 g/l,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0.565、0.634、0.576、0.623、0.602和0.463、0.781、0.407、0.818、0.704.结论 血清补体c3和c4对慢性乙型肝炎严重肝纤维化和肝硬化有一定预测价值,但效能不够稳定和可靠. abstract： objective to investigate the clinical value of serum complement c3 and c4 levels for predicting the severity of hepatic fibrosis in patients with chronic hepatitis b.methods histopathological diagnosis was confirmed in 442 patients with chronic hepatitis b.serum complement c3 and c4 levels were determined by beckman-coulter immage 800 immunochemistry system.roc curve was used to analyze the value of serum complement c3 and c4 levels in predicting the severity of hepatic fibrosis.results the areas under roc curve of complement c3 and c4 for predicting significant fibrosis ( ≥ s2),severe fibrosis ( ≥ s3) and cirrhosis (s4) were all significantly larger than the area under diagonal reference line ( p =0.009,0.000,0.000 and p =0.005,0.000,0.000,respectively).according to roc curves,the optimal Objective To investigate the clinical value of serum complement C3 and C4 levels for predicting the severity of hepatic fibrosis in patients with chronic hepatitis B.Methods Histopathological diagnosis was confirmed in 442 patients with chronic hepatitis B.Serum complement C3 and C4 levels were determined by Beckman-Coulter Immage 800 immunochemistry system.ROC curve was used to analyze the value of serum complement C3 and C4 levels in predicting the severity of hepatic fibrosis.Results The areas under ROC curve of complement C3 and C4 for predicting significant fibrosis ( ≥ S2),severe fibrosis ( ≥ S3) and cirrhosis (S4) were all significantly larger than the area under diagonal reference line ( P =0.009,0.000,0.000 and P =0.005,0.000,0.000,respectively).According to ROC curves,the optimal cut-offs of serum complement G3 for predicting severe fibrosis and cirrhosis were ≤0.74 g/L and ≤0.64 g/L,and the corresponding sensitivity,specificity,positive predictive value,negative predictive value,accuracy were 0.585,0.681,0.617,0.650,0.636 and 0.509,0.775,0.423,0.830,0.710,respectively.The optimal cut-offs of serum complement C4 for predicting severe fibrosis and cirrhosis were ≤0.14 g/L and ≤0.12 g/L,and the corresponding sensitivity,specificity,positive predictive value,negative predictive value,accuracy were 0.565,0.634,0.576,0.623,0.602 and 0.463,0.781,0.407,0.818,0.704,respectively.Conclusion Serum complement C3 and C4 may be used for predicting severe fibrosis and cirrhosis in patients with chronic hepatitis B,but its stability and reliability need to be improved.

关 键 词：肝炎 乙型 慢性 肝纤维化 补体 ROC曲线 无创诊断 

分 类 号：R575.2[医药卫生—消化系统]