基于血清蛋白电泳的比例模型判别肝纤维化程度的研究

The evaluation of liver fibrosis based on serum protein electrophoreses ratio models

目的构建基于血清蛋白电泳诊断乙型肝炎相关肝纤维化程度的数学模型,探讨提升血清蛋白电泳诊断肝纤维化程度效能的方法。方法 219例慢性乙型肝炎患者入选本研究。肝纤维化程度即慢性肝炎病理学分期分为S0、S1、S2、S3、S4五期。血清蛋白电泳采用法国Sebia公司生产的Hydrasys全自动电泳仪及其配套试剂检测。数据处理和统计分析采用Microsoft Excel2007和SPSS13.0。根据血清蛋白电泳各组分含量构成比与肝组织病理学分期之间的相关分析,构建血清蛋白电泳诊断乙型肝炎相关肝纤维化程度的比例模型。血清蛋白电泳组分含量构成比和基于血清蛋白电泳构建的比例模型诊断肝纤维化程度的评价采用Bayes逐步判别分析。结果根据Bayes逐步判别分析,血清蛋白电泳组分含量构成比诊断不同病理学分期的判别函数为:S0=-8.331+0.896×γ-球蛋白,S1=-9.284+0.958×γ-球蛋白,S2=-9.518+0.972×γ-球蛋白,S3=-9.688+0.983×γ-球蛋白,S4=-16.727+1.344×γ-球蛋白;基于血清蛋白电泳的比例模型诊断不同病理学分期的判别函数为:S0=-4.762+5.790×(α1-球蛋白+γ-球蛋白)/(α2-球蛋白+β-球蛋白),S1=-5.239+6.212×(α1-球蛋白+γ-球蛋白)/(α2-球蛋白+β-球蛋白),S2=-5.504+6.436×(α1-球蛋白+γ-球蛋白)/(α2-球蛋白+β-球蛋白),S3=-5.349+(α1-球蛋白+γ-球蛋白)/(α2-球蛋白+β-球蛋白),S4=-10.938+9.960×(α1-球蛋白+γ-球蛋白)/(α2-球蛋白+β-球蛋白)。基于血清γ-球蛋白含量构成比的判别函数诊断S0、S1、S2、S3、S4的符合率分别为63.16%、4.00%、3.28%、31.58%、62.75%;基于(α1-球蛋白+γ-球蛋白)/(α2-球蛋白+β-球蛋白)的判别函数诊断S0、S1、S2、S3、S4的符合率分别为63.16%、10.00%、40.98%、0.00%、58.82%。结论血清蛋白电泳组分含量构成比和基于血清蛋白电泳构建的比例模型诊断肝纤维化程度的效能存在差异,血清中存在目前常规检查的血清蛋白电泳不能细分的对肝纤维化程度有诊断意义的微量蛋白。

Objective To build the mathematic models based on serum protein electrophoreses for diagnosis of hepatitis B associated fibrosis,and to explore the methods of improving the efficacy of serum protein electrophoreses for evaluation of liver fibrosis.Methods Two hundred and ninteen patients with chronic hepatitis B were enrolled in present study.According to the pathological stage,the fibrotic levels were classified in five stratifications,which were S0,S1,S2,S3,S4.The proportions of fractions of serum protein electrophoreses were measured by fully-automated Hydrasys and auxiliary reagents（Sebia Electrophoresis,France）.Microsoft excel 2007 and SPSS 13.0 were used for statistical analyses.The ratio models based on fractional function for diagnosis of fibrotic levels were built according to the correlation analysis of the proportions of fractions of serum protein electrophoreses to pathological stage of liver tissue.Bayes discriminant analyses with stepwise method were used for appraisement of the proportion of fraction of serum protein electrophoreses and the ratio models grounded on serum protein electrophoreses for diagnosing the fibrotic levels.Results According to Bayes discriminant analyses by stepwise method,the discriminant functions of diagnosing the fibrotic levels based on the proportion of fraction of serum protein electrophoreses were： S0=-8.331 ＋ 0.896 × γ-globulin,S1=-9.284 ＋ 0.958 × γ-globulin,S2=-9.518 ＋ 0.972 × γ-globulin,S3=-9.688 ＋ 0.983 × γ-globulin,S4=-16.727 ＋ 1.344 × γ-globulin;the discriminant functions of diagnosing the fibrotic levels based on the ratio models based on serum protein electrophoreses were： S0=-4.762 ＋ 5.790 ×（α1-globulin ＋ γ-globulin） /（α2-globulin ＋ β-globulin）,S1=-5.239 ＋ 6.212 ×（α1-globulin ＋ γ-globulin） /（α2-globulin ＋ β-globulin）,S2=-5.504 ＋ 6.436 ×（α1-globulin ＋ γ-globulin） /（α2-globulin ＋ β-globulin）,S3=-5.349 ＋（α1-globulin ＋ γ-globulin） /（α2-globulin ＋ β-globulin）,S4=-10.938 ＋ 9.960 ×（α1-globulin ＋ γ-globulin） /（α2-globulin ＋ β-globulin）.The consistencies rate of the predicted pathological stage of the discriminant functions of diagnosing the fibrotic levels based on the proportion of serum γ-globulin with the original pathological stage were 63.16% in S0,4.00% in S1,3.28% in S2,31.58% in S3,62.75% in S4,respectively;and those based on（α1-globulin ＋ γ-globulin） /（α2-globulin ＋ β-globulin） were 63.16% in S0,10.00% in S1,40.98% in S2,0.00% in S3,58.82% in S4,respectively.Conclusion There are some differences in efficacies of diagnosing the fibrotic levels between the proportion of fraction of serum protein electrophoreses and the ratio models based on serum protein electrophoreses,and it suggests that there are trace proteins of diagnosing the fibrotic levels in the serum that could not be fractionated finely by routine serum protein electrophoreses.