肝纤维化指标、外周血常规指标和GPR对重度慢性乙型 肝炎的诊断价值及其相关性分析  

Diagnostic value and correlation analysis of liver fibrosis index,peripheral blood routine indicators and GPR for severe chronic hepatitis B

作　　者：牛梦铱 杜建新 刘桂玲 NIU Mengyi;DU Jianxin;LIU Guiling(Department of Infectious Diseases,Pingdingshan Second People′s Hospital,Pingdingshan,Henan 467000,China)

机构地区：[1]河南省平顶山市第二人民医院感染性疾病科,河南平顶山467000

出　　处：《检验医学与临床》2024年第2期178-182,共5页Laboratory Medicine and Clinic

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191261)。

摘　　要：目的评价肝纤维化指标[透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原氨基端肽(PⅢNP)和Ⅳ型胶原(ⅣC)]、外周血常规指标[包括红细胞体积分布宽度(RDW)、白细胞计数(WBC)、淋巴细胞计数(LY)、平均血小板体积(MPV)和血小板计数(PLT)]、γ-谷氨酰转移酶(GGT)与PLT比值(GPR)对重度慢性乙型肝炎的诊断价值及其相关性。方法选取2022年1月至2023年6月该院收治的120例重度慢性乙型肝炎患者作为观察组,根据Child-Pugh肝功能分级分为A、B、C级,另选取同期100例健康体检者作为对照组。采集两组清晨空腹静脉血5 mL,采用放射免疫法检测肝纤维化指标,采用全自动血细胞分析仪以速率法检测外周血常规指标,采用全自动生化分析仪以速率法检测GGT,并计算GPR。绘制受试者工作特征(ROC)曲线,统计曲线下面积(AUC),评估肝纤维化指标、外周血常规指标、GPR对重度慢性乙型肝炎的诊断价值,并对各项指标进行相关性分析。结果观察组HA、LN、PⅢNP和ⅣC水平均明显高于对照组,且肝功能越差HA、LN、PⅢNP和ⅣC水平越高,A级<B级<C级,差异均有统计学意义(P<0.05);观察组WBC和PLT均低于对照组,且A、B级PLT均高于C级,差异均有统计学意义(P<0.05),观察组RDW、MPV和GPR均高于对照组,且A级<B级<C级,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,肝纤维化指标、外周血常规指标、GPR诊断重度慢性乙型肝炎的灵敏度、特异度均较高,AUC分别为0.985、0.892、0.773。WBC、LY、PLT与肝纤维化指标均呈负相关(P<0.05),RDW、MPV与肝纤维化指标均呈正相关(P<0.05);GPR与肝纤维化指标均呈正相关(P<0.05);WBC、LY、PLT与GPR均呈负相关(P<0.05),RDW、MPV与GPR均呈正相关(P<0.05)。结论肝纤维化指标、外周血常规指标、GPR对重度慢性乙型肝炎均有较高的诊断价值,WBC、RDW、LY、MPV、PLT和GPR的变化可用来判断慢性乙型肝炎的肝纤维化程度。Objective To evaluate the diagnostic value and correlation of liver fibrosis markers[hyaluronic acid(HA),laminin(LN),procollagen typeⅢamino acid terminal peptide(PⅢNP)and typeⅣcollagen(ⅣC)],peripheral blood routine indicators[red blood cell volume distribution width(RDW),white blood cell count(WBC),lymphocyte count(LY),mean platelet volume(MPV)and platelet count(PLT)],γ-glutamyltransferase(GGT)to PLT ratio(GPR)in the diagnosis of chronic hepatitis B.Methods A total of 120 patients with severe chronic hepatitis B admitted to the hospital from January 2022 to June 2023 were selected as the observation group.According to the Child-Pugh liver function classification,they were divided into grade A,B and C,and 100 healthy subjects were selected as the control group.Fasting venous blood of 5 mL was collected from the two groups in the morning,and the liver fibrosis indicators were detected by radioimmunoassay.Peripheral blood routine indicators were detected by automatic blood cell analyzer with rate method,GGT was detected by rate method using automatic biochemical analyzer,and GPR was calculated.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the diagnostic value of liver fibrosis indicators,peripheral blood routine indicators and GPR for severe chronic hepatitis B,and the correlation between each indicator was analyzed.Results The levels of HA,LN,PⅢNP andⅣC in the observation group were significantly higher than those in the control group,and the worse the liver function,the higher the levels of HA,LN,PⅢNP andⅣC,grade A<grade B<grade C,the differences were statistically significant(P<0.05).The WBC and PLT in the observation group were lower than those in the control group,and the PLT in grade A and grade B were higher than those in grade C,the differences were statistically significant(P<0.05).The RDW,MPV and GPR in the observation group were higher than those in the control group,and grade A<grade B<grade C,the differences were st

关 键 词：慢性乙型肝炎 CHILD-PUGH肝功能分级 肝纤维化指标 外周血常规指标 γ-谷氨酰转移酶与血小板计数比值 

分 类 号：R512.62[医药卫生—内科学]