摘要
目的应用受试者工作特征(ROC)曲线分析血小板(PLT)计数与透明质酸(HA)对肝硬化的诊断价值。方法收集377例慢性HBV感染者,分为慢性乙型肝炎组233例,乙型肝炎肝硬化组144例。化学发光法检测HA,全自动血细胞分析仪检测外周血的PLT计数,进行ROC曲线分析。结果 (1)PLT计数诊断肝硬化的ROC曲线下面积(AUC)为0.888±0.0165,截断值为91×109/L,以PLT计数≤91×109/L来预测肝硬化灵敏度为84.03%,特异度为82.83%。HA的AUC为0.920±0.0138,截断值为308nmol.ml-1.h-1),以HA>308 nmol.ml-1.h-1来预测肝硬化灵敏度为84.72%,特异度为88.84%。PLT与HA的AUC之间的差异无统计学意义(P=0.089),二指标均为诊断肝硬化的优良指标。(2)以公式log10(PLT/HA)判断两个指标联合对肝硬化的诊断价值,所得AUC为0.945±0.0113,截断值为-0.595,以log10(PLT/HA)≤-0.595来预测肝硬化灵敏度为88.19%,特异度为89.7%。AUC两两比较显示log10(PLT/HA)与PLT之间的差异有统计学意义(P=0.0008);同样log10(PLT/HA)与HA之间的差异也有统计学意义(P<0.0001)。可见PLT与HA联合检测对肝硬化诊断的灵敏度和特异度更高。结论在慢性HBV感染者缺乏肝组织病理学检查时,联合检测PLT计数与HA对肝硬化的诊断比单一检测有更高灵敏度和特异度,临床价值更高。
Objective To investigate the diagnostic value of blood platelet（PLT） and hyaluronic acid（HA） levels for cirrhosis.Methods Coded peripheral blood samples obtained from chronic hepatitis B virus（HBV） infection patients（n=233） and HBV-related liver cirrhosis patients（n=144） were used to measure blood PLT counts by an automated blood cell analyzer and serum HA levels by chemiluminescent assay.Correlation of PLT counts and HA levels with HBV-related cirrhosis was analyzed by receiver operating characteristic（ROC） curve analysis.Results For PLT,the area under the curve（AUC） was 0.888±0.0165.The PLT cutoff value was determined to be≤91×109/L,which provided diagnostic sensitivity of 84.03% and specificity of 82.83%.Meanwhile,the HA AUC was 0.920±0.0138.The HA cutoff value was determined to be〉308 nmol·ml-1·h-1,which provided diagnostic sensitivity of 84.72% and specificity of 88.84%.The AUCs of PLT and HA were not significantly different（P=0.089）,suggesting that both PLT and HA are excellent indexes of cirrhosis.Furthermore,the AUC of log10（PLT/HA） was 0.945±0.0113 and the cutoff value was determined to be ≤-0.595,which provided diagnostic sensitivity of 88.19% and specificity of 89.7%.The AUC of log10（PLT/HA） and PLT（P=0.0008） was significantly different from the AUC of log10（PLT/HA） and HA（P〈0.0001）,suggesting that combined detection of PLT and HA will be more valuable for diagnosis of cirrhosis.Conclusion Combined detection of PLT and HA represents a reliable method to diagnose cirrhosis in patients with hepatitis B,and may be especially useful in cases lacking histopathologic findings.
出处
《临床肝胆病杂志》
CAS
2012年第6期456-458,共3页
Journal of Clinical Hepatology
