血清蛋白电泳诊断乙型肝炎肝纤维化程度的价值  

Appraisal of serum protein electrophoreses for discrimination of hepatitis B associated fibrotic levels

作　　者：张占卿[1] 陆伟[1] 陈淑琴[1] 王雁冰[1] 饶敏[1] 童海涛[2] 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,上海201508 [2]上海市公共卫生临床中心病理科,上海201508 [3]上海市公共卫生临床中心检验科,上海201508

出　　处：《临床荟萃》2011年第11期945-947,958,共4页Clinical Focus

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)诊断乙型肝炎肝纤维化程度的价值。方法慢性乙型肝炎219例,其中病理学诊断为S0、S1、S2、S3、S4的患者分别为19例、50例、61例、38例、51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。统计分析采用SPSS 13.0软件。SPE各组分含量构成比诊断肝纤维化程度的评价采用Bayes逐步判别分析,分析方法采用Wilks lambda法,模型纳入变量的F>3.84,剔除变量的F<2.71。结果血清白蛋白和α2-球蛋白与病理学分期呈显著负相关(rs=-0.388、-0.240,均P<0.01),α1-球蛋白和γ-球蛋白与病理学分期呈显著正相关(rs=0.253、0.418,均P<0.01),β-球蛋白与病理学分期无显著相关性(rs=-0.129,P>0.05)。符合模型纳入变量、进入判别函数的指标只有血清γ-球蛋白含量构成比。判别函数诊断S0、S1、S2、S3、S4的符合率分别为63.2%、4.0%、3.3%、31.6%、62.8%。结论SPE各组分中,只有血清γ-球蛋白含量构成比对乙型肝炎肝硬化有诊断价值;基于SPE构建的判别函数对非肝硬化不同纤维化程度的鉴别能力有限。Objective To explore the efficacy of proportions of fractions of serum protein electrophoreses for diagnosis of hepatitis B associated fibrotic levels.Methods 219 consecutive patients with chronic hepatitis B were studied,in which 19 patients,50 patients,61 patients,38 patients,51 patients were pathologically diagnosed as S0,S1,S2,S3,S4 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 analysis.Bayes stepwise discriminant analysis was used for appraisal of the proportions of fractions of serum protein electrophoreses for diagnosis of different fibrotic levels,in which Wilks lambda method was used,and the entry and removal criteria of the independents were F〉3.84 and 〈2.71 respectively.Results The proportions of serum albumin and α2-globulin were negatively correlated significantly to the pathological stages（rs=-0.388,-0.240,both P〈0.01）,the proportions of serum α1-globulin and γ-globulin were positively correlated significantly to the pathological stages（rs=0.253,0.418,both P〈0.01）,and the proportion of serum β-globulin was not correlated to the pathological stages（rs=-0.129,P〉0.05）.Only serum γ-globulin entered the discriminant functions according to the entry criteria of the functions.The correctly classified rates of the original grouped cases by the discriminant functions were 63.2% for S0,4.0% for S1,3.3% for S2,31.6% for S3,62.8% for S4,respectively.Conclusion Only the proportion of serum γ-globulin has the diagnostic value for hepatitis B associated cirrhosis in fractions of serum protein electrophoreses;the discriminant functions based on the proportion fractions of serum protein electrophoreses is limited for discrimination of different fibrotic levels in patients with non-cirrhosis.

关 键 词：肝炎 乙型 肝硬化 血蛋白质类 

分 类 号：R575.2[医药卫生—消化系统]