外周血可溶性sH2a在早期诊断肝纤维化程度中的价值

The clinical diagnosis value and significance of serum sH2a level on early hepatic fibrosis degree

目的 研究血清肝纤维化标志物sH2a用于诊断慢性肝病患者早期肝纤维化的临床诊断价值及意义.方法 收集67例行肝穿刺活检的慢性乙型肝炎、脂肪性肝病或两者合并患者作为研究对象,通过sH2a试剂盒检测外周血中可溶性sH2a的含量,与实验室指标及肝组织病理纤维化程度进行比较,并绘制特征曲线（ROC）,计算曲线下面积（AUC）,分析其敏感性和特异性以评估该血清标志物对早期肝纤维化的诊断价值.结果 患者血清sH2a水平与肝脏纤维化程度呈负相关,且无纤维化（S0期）、早期纤维化（S1-S2期）和中晚期纤维化（S3-S4期）3组之间的差异有统计学意义（P＜0.05）.预测有无纤维化发生时,最佳诊断阈值为0.79,敏感性和特异性分别为63％、80％,AUC为0.772;评估有无明显纤维化发生时,当sH2a为0.77时,AUC为0.806,诊断灵敏度为85.7％,特异性为72.7％.结论 运用sH2a评估患者肝脏纤维化程度,可有效诊断患者肝脏早期纤维化,在区分有无明显纤维化上诊断价值更高,为临床诊断及治疗提供可靠依据.

Objective We aimed,in our prospective study,to assess the predictive value of serum non-invasive and biochemical markers for clinical diagnosis of significant fibrosis （including early stages）.Methods We measured sH2a levels in serum,comparing with routine liver function markers.We compared blindly pretreatment serum samples from a cohort of hepatitis B patients without non-alcoholic fatty liver disease （NAFLD）,which had histological grades of liver fibrosis,with NAFLD individuals and CHB with NAFLD patients.Statistical analysis was by Student＇s t test,and receiver-operating characteristic （ROC） curves were drawn.Results ROC curves showed that serum sH2a had greater diagnostic performance than routine liver function markers compared with histological grades of liver fibrosis（S0,S1-2,S3-4）.ROC curves showed that using a sH2a cut-off point of 0.79 was with highest sensitivity as 63% and highest specificity as 80%.And sensitivity as 96.7% and specificity as 75.5% when using a sH2a cut-off point of 0.77.Conclusions sH2a has the potential to be a uniquely sensitive and specific novel marker for liver fibrosis and function.