免疫球蛋白三项联合预测乙肝伴肝衰竭预后的临床价值  

Predictive value of combined detection of three immunoglobulin in the prognosis of hepatitis B with liver failure

作　　者：薛莲[1] 张群先[1] XUE Lian;ZHANG Qunxian(Department of Medical Laboratory,The People＇s Hospital of Hechi,Hechi 547000,Chin)

机构地区：[1]广西河池市人民医院检验科,河池547000

出　　处：《右江医学》2018年第2期205-209,共5页Chinese Youjiang Medical Journal

摘　　要：目的探讨免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)三项联合检测对乙肝伴肝衰竭预后的预测价值。方法纳入2015年10月~2016年10月间收治的乙肝伴肝衰竭患者80例。于患者出院前1 d测定IgA、IgG、IgM水平。随访12个月,分析随访期间患者预后情况,根据预后分为预后良好组(肝细胞大量再生超过坏死)、预后不良组(肝细胞大量坏死、死亡)。通过受试者工作特征曲线(ROC)分析免疫球蛋白三项联合检测对乙肝伴肝衰竭的预测价值,利用多因素Logistic回归分析明确患者预后不良的独立因素。结果在80例患者中,预后良好51例(63.75%),预后不良29例(36.25%),其中死亡17例(21.25%),肝细胞大量坏死12例(15.00%);预后良好组的肝衰竭晚期占比为3.92%,低于预后不良组的34.48%,且预后良好组的IgA、IgG、IgM水平均低于预后不良组,差异有统计学意义(P<0.05);肝衰竭分期、IgA、IgG、IgM与预后不良存在关联性(P<0.05);IgA、IgG、IgM三项联检预测乙肝伴肝衰竭预后不良的敏感度为90.6%,特异度为89.5%,较三项单独预测的敏感度、特异度更高。结论IgA、IgG、IgM与乙肝伴肝衰竭预后有较高关联性,联合检测上述三项指标有利于预测预后。Objective To investigate the predictive value of combined detection of immunoglobulin A （IgA）, immunoglobulin G （IgG） and immunoglobulin （IgM） in the prognosis of hepatitis B with liver failure.Methods 80 patients with hepatitis B with liver failure admitted to hospital from October 2015 to October 2016 were selected.The levels of IgA, IgG and IgM were measured at I D before discharge.The patients were followed up for 12 months,and the prognosis of the patients during the follow-up period was analyzed.According to the prognosis,the patients were divided into good prognosis group （massive liver regeneration over necrosis） and poor prognosis group （massive necrosis and death of hepatocytes ）.The predictive value of combined detection of the three immunoglobulin levels in hepatitis B patients with liver failure was analyzed by drawing the receiver operating characteristic（ ROC ） curve.And the independent factors of poor prognosis in patients were identified by multivariate Logistic regression analysis.Results Among the 80 patients,51 cases （63.75%） had good prognosis,29 cases （36.25%） had poor prognosis, 17 cases died （21.25%）, and 12 cases （15.00%） had massive necrosis of hepatocytes. The proportion of advanced liver failure in good prognosis group was 3.92% ,which was lower than that（ 34.48% ） in the poor prognosis group,and the levels of IgA,IgG and IgM in the good prognosis group were lower than those in the poor prognosis group, difference was statistically significant （P〈0.05）.The staging of liver failure, IgA, IgG and IgM were associated with poor prognosis（P〈0.05） .The sensitivity of the combined detection of IgA, IgG and IgM in predicting the prognosis of hepatitis B with liver failure was 90.6% ,and the specificity was 89.5% ,which were higher than those of the three items alone.Conclusion IgA, IgG, IgM are significantly associated with the prognosis of hepatitis B with liver thilure, and the combined detection of three indicators is beneficial to pre

关 键 词：乙型肝炎 肝衰竭 免疫球蛋白 预后 

分 类 号：R512.62[医药卫生—内科学]