非侵袭性指标S指数与血清HA联合诊断慢性乙肝肝纤维化的临床应用

Clinical Application of Noninvasive Target S Index Combined with Serum Hyaluronic Acid in the Diagnosis of Liver Fibrosis in Chronic Hepatitis B

目的:探讨慢性乙型肝炎(CHB)肝纤维化非侵袭性诊断指标S指数与血清透明质酸(HA)联合应用的临床诊断价值。方法:对76例CHB患者行肝活检分期,参照有关文献通过γ﹣谷氨酰转肽酶(GGT)、血小板(PLT)和白蛋白(Alb)三个常规项目计算S指数[S指数=1000×GGT/(PLT×Alb2)],同时应用放射免疫分析测定血清HA。结果:单用S指数(以0.1为阴性界值,0.5为阳性界值)作为排除和诊断显著肝纤维化的指标,可避免44.7%(34/76)的肝活检,其准确率为73.5%(25/34);用HA对未被S指数确定的42例患者进行再评价,又可避免57.1%(24/42)的肝活检,其准确率为79.2%(19/24);将S指数与血清HA进行联合应用,则可避免76.3%(58/76)的肝活检,其准确率为75.9%(44/58)。结论:S指数与血清HA的联合应用及动态监测可提高无创评估CHB肝纤维化的诊断效率,减少或避免肝活检。

Objective To explore the diagnostic value of noninvasive target S index in combination with serum hyalumnic acid （HA） in the diagnosis of liver fibrosis in chronic hepatitis B （CHB）. Mothods Liver biopsy staging was performed in 76 patients with CHB, by referring to relevant literatures, the S index consisted of GGT,PLT and albumin（Alb） [ S index = 1000 × GGT/（PLT × Alb2） ） , serum HA was determined by RIA. Results Using S index （0.1 for negative tolerances, 0.5 for positive tolerances）as the index of eliminating and diagnosing significant liver fibrosis, the need for liver biopsy would reduce by 44.7% （34/76） with an accuracy rate of 73.5% （25/34） ;42 patients unidentified by S index were assessed by serum HA, the need for liver biopsy would reduce by 57.1% （ 24/42 ） with an accuracy rate of 79.2% （ 19/24 ） ;Combining S index and serum HA, the need for liver biopsy would reduce by 76.3 % （58/76） with an accuracy rate of 75.9% （44/58）. Conclusion A combination and dynamic monitoring of S index and serurn HA improves the diagnostic performance for liver frosis in CHB patients and reduce or avoid the liver biopsy.