凝血酶原时间与肝促凝血活酶试验在慢性乙型病毒性肝炎纤维化分期的诊断价值

The diagnostic values of prothrombin time and hepaplastin test in evaluating liver fibrosis staging in patients with chronic hepatitis B

判断凝血酶原时间(PT)与肝促凝血活酶试验(HPT)诊断慢性乙型病毒性肝炎患者肝纤维化分期的作用。选取72名经肝活检病理证实的慢性乙型病毒性肝炎患者,检测不同肝纤维化分期血浆PT及HPT(分别以秒、活动度、率及国际标准化比率计),并通过ROC曲线分析两者诊断肝纤维化、早期肝硬化的价值。慢性乙型病毒性肝炎患者S0-S3期PT组间无差异,只有S4期明显升高或降低,且与S0、S1、S2、S3期比较有显著性差异(P<0.01)。而HPT S0-S2组间无显著性差异外,其它两两比较均有显著性差异(P<0.01)。通过ROC曲线分析,PTs及HPTs诊断S4的阈值为14.05秒、19.75秒时,敏感度及特异度分别为0.889、0.814;0.889、0.907。PTA及HPTA的诊断阈值为85.5%、70.5%时,诊断S4期的敏感度及特异度分别为0.889、0.814;0.889、0.907。因此,HPT、PT在肝纤维化分期的诊断中有一定的作用,且前者优于后者。

To investigate the role of prothrombin time （PT） and hepaplastin test （HPT） in evaluating liver fibrosis staging in patients with chronic hepatitis B. Seventy - two plasma samples from patients with chronic hepatitis B were detected for PT and HPT. Liver biopsy was performed in all patients. The values of PT and HPT in diagnosing liver fibrosis staging and early cirrhosis were compared. With degree of liver fibrosis increasing, the difference of PT between SO - S3 was not statistically significant. But it changed markedly in S4. The difference between S4 and S0, S1, S2 and S3 was statistically significant （P 〈0. 01 ）. The difference of HPT between every two groups was statistically （P 〈0. 01 ）, except between S0, S1 and S2. ROC analysis showed when 14. 05 second, 19. 05 second were used as the cut - off of PTs, HPTs for diagnosing S4, the sensitivity and specificity were 0. 889, 0. 814 and 0. 889, 0. 907 respectively. When 85.5% , 70. 5% as the cut - off of PTA and HPTA for diagnosing S4, the sensitivity and specificity were 0. 889, 0. 814 and 0. 889, 0. 907 respectively. HPT and PT had some values in evaluating liver fibrosis staging. And the former was superior to the later.