血清白蛋白和球蛋白对乙型肝炎相关肝硬化的诊断意义  

The practical value of serum albumin and globulin for diagnosing hepatitis B-associated cirrhosis

作　　者：张占卿[1] 陆伟[1] 崔晨蓉[1] 史连国[1] 

机构地区：[1]上海市复旦大学附属公共卫生临床中心肝病科,201508

出　　处：《实用医学杂志》2009年第3期374-376,共3页The Journal of Practical Medicine

摘　　要：目的:评价血清白蛋白(albumin,ALB)、球蛋白(globulin,GLB)水平和白蛋白/球蛋白(A/G)比值诊断肝硬化的价值。方法:慢性乙型肝炎患者172例,其中病理诊断为肝硬化的患者28例,非肝硬化的患者144例。1s肝穿刺法行肝组织活检,用光学显微镜多视野观察进行组织学分级和分期。肝穿刺前后1周内早晨空腹采血,分离血清后用Roche Modular-P全自动生化分析仪测定血清ALB、GLB。结果:血清ALB水平和A/G比值诊断非肝硬化的ROC曲线下面积分别为0.221(95%CI:0.138～0.304)和0.229(95%CI:0.133～0.326),血清GLB水平诊断肝硬化的ROC曲线下面积为0.720(95%CI:0.617～0.824)。血清ALB和GLB水平和A/G比值诊断肝硬化的最佳截断值分别为40.35g/L、34.70g/L和0.98,其诊断肝硬化的灵敏度、特异度、阳性预测值、阴性预测值、准确度、Youden指数分别为0.821和0.607和0.571、0.646和0.771和0.868、0.311和0.340和0.457、0.949和0.910和0.912、0.674和0.744和0.818、0.467和0.378和0.439。结论:血清ALB、GLB水平和A/G比值均可用作否定诊断肝硬化的参考指标。Objective ／To evaluate the practical value of serum levels of albumin （ALB） and globulin （GLB） and the albumin/globulin （A/G） ratio for diagnosing hepatitis B- associated cirrhosis. Methods 28 of 172 patients with chronic hepatitis B were pathologically diagnosed as cirrhosis but another 144 had no cirrhosis. The SPSS 12.0 was used for statistical analyses. Serum levels of ALB and GLB and the A/G ratio for diagnosing cirrhosis were evaluated with the ROC curve. Results The areas under the ROC curves of serum ALB level and the A/G ratio for diagnosing non-cirrhosis were 0.221 （95% CI： 0.138 - 0.304） and 0.229 （95% CI： 0.133 - 0.326）, respectively. The area under the ROC curve of serum GLB level for diagnosing cirrhosis was 0.720 （95% CI： 0.617 - 0.824）. The optimal cut-off values of serum ALB and GLB levels and the A/G ratio for diagnosing cirrhosis were 40.35 g/L,34.70 g/L,and 0.98, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden＇s index were 0.821, 0.646, 0.311, 0.949, 0.674, and 0.467 for ALB,0.607, 0.771, 0.340, 0.910, 0.744, and 0.378 for GLB, and 0.571, 0.868, 0.457, 0.912, 0.818, and 0.439 for A/G, respectively. Conclusion Serum levels of ALB and GLB and the A/G ratio can be used as the reference indices for excluding the dignosis of cirrhosis.

关 键 词：肝炎 乙型 慢性 肝硬化 白蛋白类 球蛋白类 ROC曲线 白蛋白/球蛋白比值 

分 类 号：R512.62[医药卫生—内科学] R446.112[医药卫生—临床医学]