丙型肝炎相关自身抗体和血清AST/ALT比值对丙肝后肝硬化的诊断价值

The diagnostic values of autoantibodies and AST/ALT ratio in hepatitis C-associated cirrhosis

目的:检测丙型肝炎患者血清自身抗体和门冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)比值,探讨两者与肝组织病理学检查在预测丙肝后肝硬化的一致性。方法:采用间接免疫荧光法测定抗核抗体(ANA)、抗平滑肌抗体(SMA)、抗线粒体抗体(AMA)和抗肝肾微粒体抗体(LKM),并同时检测肝功能指标ALT、AST。应用Kappa评价方法,对丙肝相关自身抗体和AST/ALT比值预测肝硬化结果与病理诊断结果进行诊断一致性分析。结果:丙肝相关自身抗体和肝组织病理学检查对丙肝后肝硬化的诊断具有较好的一致性,其诊断丙肝后肝硬化的敏感性为59.3%、特异性为90.3%、准确性为78.3%;血清AST/ALT比值和肝组织病理学检查对丙肝后肝硬化的诊断具有极好一致性,其诊断肝硬化的敏感性为81.4%、特异性为93.5%、准确性为88.8%。结论:丙肝相关自身抗体和血清AST/ALT比值测定有助于丙型肝炎肝硬化的诊断,值得临床推广应用。

Objective To determine serum autoantibodies and AST/ALT ratio in patients with hepatitis C and to explore the agreement of the two biochemical parameters for predicting hepatitis C-associated cirrhosis with the pathological findings. Methods Serum levels of ANA, SMA, AMA, and LKM were detected in all the patients using indirect immunofluorescence assay, and levels of AST and ALT were also measured. The agreement of autoantibodies and AST/ALT ratio for predicting cirrhosis with the pathological diagnosis was analyzed by Kappa test. Results Good agreement was found between autoantibodies for predicting cirrhosis and the pathological diagnosis. The sensitivity of prediction with autoantibodies was 59.3%, the specificity 90.3%, and the accuracy 78.3%. Super agreement was found between AST/ALT ratio for predicting cirrhosis and the pathological diagnosis. The sensitivity of prediction with AST/ALT ratio was 81.4%, the specificity 93.5%, and the accuracy 88.8%. Conclusions Detection of autoantibodies and AST/ALT ratio is helpful in diagnosing cirrhosis associated with hepatitis C.