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目的 比较肝纤维化血清标志物对慢性乙型肝炎(CHB)代偿性肝硬化的诊断评价,筛选可行的无创性诊断标志物。方法 350例CHB患者经皮肝脏穿刺活检术行病理组织学检查,B型超声波检查肝硬化图像,检测血清透明质酸(HA)、Ⅲ型前胶原肽(PCⅢ)、层黏连蛋白(LN)及Ⅳ型胶原(CⅣ)等肝纤维化标志物,用临床流行病学方法确定诊断截断值,并对各项指标作诊断评价分析,比较不同标志物的诊断评价指标。 结果 85例CHB患者经肝脏活检术确认为代偿性肝硬化;81例经B型超声波检查有肝硬化图像;ROC曲线下面积以HA最高;血清HA、PCⅢ、LN及C Ⅳ对代偿期肝硬化的诊断截断值分别为1 54.3 5μg/L、198.44μg/L、137.58μg/L和100.80μg/L,其对应诊断灵敏度分别为82.4％、63.5％、57.3％及70.6％,特异度为79.3％、54.0％、56.8％及68.3％,准确度为80.0％、56.3％、56.9％及68.9％;并联试验诊断虽可提高灵敏度,但相应降低特异度及准确度。与其他无创性诊断方法比较,HA有较高水平的诊断评价指标(u≥1.814,P<0.05)。血清HA诊断代偿性肝硬化的截断值以119.17μg/L较为恰当,其相应诊断灵敏度、特异度、准确度、阳性预告值及阴性预告值分别为87.1％、67.6％、72.3％、46.25％、94.7％。结论 在现有肝脏纤维化血清标志物及超声波检查等无创性诊?
Objective To compare the diagnostic value of serum markers of liver fibrosis in the diagnosis of chronic hepatitis B (CHB) compensatory cirrhosis and screen feasible noninvasive diagnostic markers. Methods Percutaneous liver biopsy in 350 CHB patients was performed histopathological examinations. Liver cirrhosis images were examined by ultrasound B, and the levels of serum hyaluronic acid (HA), type Ⅲ procollagen peptide (PC Ⅲ), laminin (LN) And type Ⅳ collagen (C Ⅳ) markers such as liver fibrosis, with clinical epidemiological methods to determine the diagnostic cutoff value, and the diagnosis and evaluation of each indicator to analyze the diagnostic indicators for different markers. Results Eighty-five patients with CHB were confirmed by liver biopsy as compensated cirrhosis. Eighty-one patients underwent type B ultrasound examination with liver cirrhosis. The area under ROC curve was the highest with HA. Serum HA, PCⅢ, LN, The diagnostic cut-off values of cirrhosis were 154.3 5μg / L, 198.44μg / L, 137.58μg / L and 100.80μg / L, respectively. The diagnostic sensitivities of the two methods were 82.4%, 63.5%, 57.3% and 70.6% 79.3%, 54.0%, 56.8% and 68.3% respectively. The accuracy was 80.0%, 56.3%, 56.9% and 68.9% respectively. Although parallel diagnostic tests could improve the sensitivity, they reduced the specificity and accuracy. Compared with other noninvasive diagnostic methods, HA has a higher diagnostic evaluation index (u≥1.814, P <0.05). The cutoff value of serum HA in diagnosing compensated cirrhosis was 119.17 μg / L, which was 87.1%, 67.6%, 72.3% and 46.25% respectively for the corresponding diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value. , 94.7%. Conclusion In the existing liver fibrosis serum markers and ultrasound examination and other non-invasive diagnosis?