红细胞分布宽度、平均体积和血清淀粉样蛋白A对乙型肝炎肝硬化肝脏受损程度的诊断价值

Value of mean corpuscular volume,red blood cell distribution width and serum amyloid A protein in quantitative diagnosis of liver damage in patients with hepatitis B cirrhosis

目的:探究红细胞平均体积(MCV)、红细胞分布宽度(RDW)和血清淀粉样蛋白A(SAA)对乙型肝炎肝硬化患者肝脏受损程度量化诊断价值。方法:以107例乙型肝炎肝硬化患者(肝硬化组)、89例乙型肝炎患者(乙肝组)和65名健康体检者(对照组)为研究对象,检测患者MCV、RDW、SAA水平、肝功能指标和CT肝脏体积,分析各项指标之间的相关性,应用受试者工作特征曲线(ROC)评估MCV、RDW和SAA对乙型肝炎肝硬化的诊断价值。结果:白蛋白(ALB)和血小板(PLT)水平在肝硬化组、乙肝组和对照组中明显增加(P<0.05),谷草转氨酶(AST)、谷丙转氨酶(ALT)、凝血酶原时间(PT)、国际标准化比值(INR)、白细胞(WBC)、乙型肝炎E抗原(HBeAg)、MCV、RDW和SAA在肝硬化组、乙肝组和对照组明显降低(P<0.05),肝硬化组的乙型肝炎病毒的脱氧核糖核苷酸(HBV-DNA)水平高于乙肝组(P<0.05)。肝硬化组患者根据肝组织穿刺活检结果分为轻度损伤(n=34)、中度损伤(n=51)和重度损伤(n=22)组,三组的MCV、RDW、SAA水平和CTP、MELD评分比较,轻度损伤<中度损伤<重度损伤(P<0.05),CT肝脏体积比较,轻度损伤>中度损伤>重度损伤(P<0.05)。相关性分析结果显示,MCV、RDW、SAA水平与CTP评分、MELD评分均成明显正相关(P<0.05),与CT肝脏体积呈明显负相关(P<0.05)。ROC曲线分析结果显示,MCV、RDW和SAA对乙型肝炎肝硬化的诊断均具有统计学意义(P<0.05),MCV、RDW和SAA联合检测的敏感度和特异度分别为80.00%和71.48%,AUC值为0.841,高于单个指标检测(P<0.05)。结论:MCV、RDW和SAA水平与乙型肝炎肝硬化密切相关,可作为乙型肝炎肝硬化诊断的临床指标之一。

Objective:To explore the value of mean corpuscular volume(MCV),red blood cell distribution width(RDW)and serum amyloid A(SAA)protein in quantitative diagnosis of liver damage in patients with hepatitis B cirrhosis.Methods:107 patients with hepatitis B cirrhosis(cirrhosis group),89 patients with hepatitis B(hepatitis B group),and 65 healthy individuals(control group)were enrolled in the study.The MCV,RDW,SAA level,liver function indicators and CT liver volume were tested.The correlation of MCV,RDW and SAA level with liver function indicators and CT liver volume were analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the value of MCV,RDW and SAA in the diagnosis of hepatitis B cirrhosis.Results:The albumin(ALB)and platelet(PLT)levels in cirrhosis group,hepatitis B group,and control group increased significantly(P<0.05),while the levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),prothrombin time(PT),international normalized ratio(INR),white blood cell(WBC),HBeAg,MCV,RDW,and SAA levels decreased significantly(P<0.05).The HBV-DNA level in cirrhosis group was significantly higher than that in the hepatitis B group(P<0.05).According to the liver biopsy results,patients in the cirrhosis group were divided into mild injury group(n=34),moderate injury group(n=51)and severe injury group(n=22).The MCV,RDW,SAA levels,CTP and MELD scores of the mild injury group,moderate injury group,and severe injury group increased in turn(P<0.05).CT liver volume of the three groups decreased in turn(P<0.05).Correlation analysis results showed that MCV,RDW,and SAA level were significantly positively correlated with CTP score and MELD score(P<0.05),and were significantly negatively correlated with CT liver volume(P<0.05).ROC curve analysis found that MCV,RDW and SAA could be used to diagnose hepatitis B cirrhosis(P<0.05).The sensitivity and specificity of combined detection of MCV,RDW and SAA were 80.00%and 71.48%,respectively.The AUC value was 0.841,which was significantly higher than that of each index(P<0.05).Conclusion:MCV,RDW,and SAA levels are closely related to hepatitis B cirrhosis,which can be used as one of the clinical indicators for diagnosing hepatitis B cirrhosis.