PGA指数和透明质酸在诊断慢性乙肝肝纤维化中的价值  

The Values of PGA Index and HA in Diagnosis of Fibrosis in the Liver with Chronic Hepatitis B

作　　者：顾立祥 江圣勇[2] 何伟芳 唐锡尔 

机构地区：[1]浙江省宁波市北仑区宗瑞医院,宁波315806 [2]浙江省宁波市第二医院,宁波315010 [3]浙江省宁波市肝病医院,宁波315020

出　　处：《中国临床医学》2002年第5期496-498,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:寻找一种简便实用的诊断慢性乙型肝炎肝纤维化的方法。方法:以78例经肝穿刺病理证实的慢性乙型肝炎为对象,测定并比较了由PT、GGT、ApoA1组成的PGA指数和HA、LN、PⅢP、C-Ⅳ与肝内纤维化程度(S)和炎症活动度(G)的关系。结果:①LN、PⅢP、C-Ⅳ在轻度慢性乙肝时无明显升高,在中度慢性乙肝时明显高于正常,但与轻度慢性乙肝无差异,而PGA指数和HA不仅在轻度慢性乙肝时显著升高,而且在轻中度间差异明显。在重度慢性乙肝和活动性肝硬化时,五项指标均显著增高。②在G2—4期,HA、LN、PⅢP、C-Ⅳ均明显升高,但在G1期,只有PGA指数高于正常,且各期间差异显著。③在S1—2期,只有PGA指数、HA、C-Ⅳ明显上升,但C-Ⅳ的上升幅度远低于PGA指数和HA。④如以PGA>4.5或HA>200μg/L作为判断临界值,则两者判断肝纤维化的敏感性均>94％,精确性>91％,特异性>86％,如两者结合,则分别达到98.3％、95.2％和96.4％。结论:PGA指数和HA均是反映慢性乙型肝炎患者肝内纤维化程度的良好指标,两者联合检测则可达到最大的价值效益比。Objective: To find a simple and practical method to diagnosis liver fibrosis in chronic hepatitis B (CH - B). Methods : In 78 cases with CH - B diagnosed by pathological histology, the relationship of the serum PGA index and HA, LN, Pb! P and C- IV with the stage of fibrosis (S) and the grade of inflammation (G) in the liver were compared. Results: `$LN, P b!P, C- IV did not raise in mild CH - B, but obviously increased in moderate CH - B compared with normal levels. There were no difference between mild and moderate CH - B for LN, Pb!P and C - IV. Otherwise, levels of PGA index and HA raised in mild CH - B, and there were difference between mild and moderate CH - B. a$ The levels of PGA index, HA, LN, Pb!P and C - IV were related to G2 - 4, but only PGA index was related to Gl and different between each grade of inflammation . b$ In S1 - 2, only PGA index, HA and C -IV were gone up, but the raising extent of C - IV was evidently lower than PGA index and HA. c$ The sensitivity, accuracy and specificity of PGA index >4.5or HA > 200?g/L were over 94% , 91% and 86% respectively. Combination with both of them could get to 98.3% in sensitivity, 95.2% in accuracy and 96. 4% in speciality. Conclusion: Both of PGA index and HA are helpful to dignose the stage of liver fibrosis with CH -B. Combination of them can get cost effect rate.

关 键 词：肝纤维化 PGA指数 透明质酸 层粘连蛋白 Ⅲ型前胶原肽 Ⅳ型胶原 慢性乙型肝炎 

分 类 号：R575.2[医药卫生—消化系统] R512.[医药卫生—内科学]