血清免疫球蛋白对非酒精性脂肪性肝病肝纤维化的诊断价值分析

Diagnosis value of serum immunoglobulin for liver fibrosis in patients with non-alcoholic fatty liver disease

目的探讨血清免疫球蛋白对诊断非酒精性脂肪性肝病（NAFLD）患者肝纤维化的价值。方法以泰州市人民医院及苏州大学附属第一医院2011年1月至2014年3月间进行肝组织活检确诊的98例NAFLD患者为研究对象，回顾性分析肝组织病理学分期及血清免疫球蛋白、生化、体重指数（BMI）等指标，用受试者操作特征（ROC）曲线等方法评估其诊断价值。结果98例患者中男性65例，病理肝纤维化分期提示显著纤维化（S3～S4）38例。显著纤维化组的年龄、BMI、ALT、ALB、血小板计数、血清IgA与对照组比较差异有统计学意义（P〈0．05）；IgA、FIB-4、APKI对肝脏显著纤维化都具有一定诊断价值，三者曲线下面积分别为0．857、0．783、0．782。IgA阳性预测值达85％。结论血清IgA可作为诊断肝纤雏化进展的指标之一。

Objective To testifythe diagnostic value of serum immunoglobulin in patients with non-alcoholic fattyliver disease （NAFLD） by comparing their results with histological features. Methods Serum immunoglobulin, biochemical indexes, and body mass index （BMI） and other indicators were determined in 98 patients with biopsy-proven NAFLD. The receiver operating characteristic （ROC） curve and other methods were used to evaluate its diagnostic value. Results In 98 cases, there were 65 males, of which 38 cases had advanced fibrosis （$3-$4）. The levels of age, BMI, ALT, ALB, PLT, and IgA in the patients with advanced fibrosis were significantly higher than those in the controls （P 〈 0.05）; IgA, FIB-4, APRI aU had certain values in the diagnosis of liver fibrosis, and the area under the curve （AUROC） were 0.857, 0.783 and 0.782, respectively; and the positive predictive value oflgA was up to 85%. Conclusion Serum IgA can be used as a diagnosis index of advanced liver fibrosis.