摘要
目的探讨前白蛋白（PA）、总胆汁酸（TBA）和红细胞体积分布宽度（RDW）在慢性肝病中的临床应用价值。方法选取2015年3月至2016年3月入住中南大学湘雅医院的393例慢性肝病患者作为研究对象，并将其分为慢性肝炎组、肝硬化代偿期组、肝硬化失代偿期组和原发性肝癌组，选取同期健康体检者200例作为正常对照组，分别检测PA，TBA和RDW。采用SPSS17．0软件对数据资料进行统计学处理。绘制受试者工作特征曲线（ROC），并研究其联合检测价值。结果研究对象组的PA明显低于对照组，TBA与RDW明显高于对照组，差异均有统计学意义（P〈0．05）。以临床诊断为金标准，PA分别以244．7mg／L、238．5mg／L和132，8mg／L为界诊断原发性肝癌、慢性肝炎＋肝硬化代偿期和肝硬化失代偿期性能最高，曲线下面积分别为0．973、0．909和0．879，敏感度分别为92．3％、95．1％和85．6％，特异度分别为95．8％、72．8％和79．7％。RDW分别以13．2％、13．8％和14．3％为界诊断原发性肝癌、慢性肝炎和肝硬化性能最高，曲线下面积分别为0．816、0．827和0．818，敏感度分别为66．7％、77．4％和72．2％，特异度分别为79．5％、73．8％和77．3％。当联合检测PA和RDW时，其诊断性能明显提高。结论PA、TBA以及RDW可作为慢性肝病早期诊断的指标；联合检测PA、RDW对诊断慢性肝病严重程度具有较好的敏感度和特异度，对临床判定疾病严重程度具有重要意义。
Objective To explore the clinical application value of the prealbumin （PA） , total bile acid （TBA） , and red blood cell volume distribution width （RDW） in chronic liver disease. Methods Totally 393 cases of patients with chronic liver disease admitted by Xiangya Hospital of Central South University from March 2015 to March 2016 were selected as group observation, and were divided into chronic hepatitis, compensated liver cirrhosis, decompensated liver cirrhosis and primary liver cancer. At the same time, 200 cases of healthy volunteers were collected as normal control. Serum prealbumin and total bile acids were tested as well as the RDW of all cases. SPSS 17. 0 software was used for data statistics processing. The receiver - operating characteristic curve （ ROC ） was drawn to evaluate the diagnosis value of the indexes in chronic liver disease severity. Results PA in the observation group was significantly lower than normal control, while its TBA and RDW were significantly higher than normal control. All of three parameters in patients, especially with liver cirrhosis and decompensated liver cirrhosis, had higher positive rate. When the clinical diagnosis was taken as gold standard, the best level of PA to diagnose primary liver cancer, chronic hepatitis and decompensated liver cirrhosis was 244. 7 mg/L, 238.5 mg/L and 132. 8 mg/L, the AUC was 0. 973, 0. 909 and 0. 879, the sensitivity was 92. 3% , 95.1% and 85.6% , and the specificity was 95.8% , 72. 8% and 79. 7% ; the best level of RDW to diagnose primary liver cancer, chronic hepatitis and decompensated liver cirrhosis was 13.2% , 13.8% and 14. 3%, the AUC was 0. 816, 0. 827 and 0. 818, the sensitivity was 66. 7%, 77. 4% and 72. 2%, and the specificity was 79. 5%, 73. 8% and 77. 3%. When combined detection of PA and RDW, the diagnostic performance had improved significantly. Conclusions Serum prealbumin and total bile acid, as well as the whole blood RDW may objectively reflect the injury of liver metabolism and synthesis function, and for the early diagnosis and prognosis of patients with chronic liver disease has a important clinical significance.
出处
《中国医师杂志》
CAS
2017年第2期239-242,共4页
Journal of Chinese Physician
