血清GFAP、MCP-1联合血氨对重型肝炎并发肝性脑病的诊断价值

Diagnostic value of serum GFAP and MCP-1 combined with serum ammonia in severe hepatitis complicated with hepatic encephalopathy

目的:探讨血清神经胶质纤维酸性蛋白(GFAP)、单核细胞趋化蛋白-1(MCP-1)和血氨对重型肝炎并发肝性脑病(HE)的诊断价值。方法:检测58例重型肝炎并发HE患者(并发HE组,其中HE 0~1级26例、HE 2级19例、HE 3~4级13例)及58例重型肝炎未并发HE患者(未并发HE组)血清GFAP、MCP-1水平及血氨水平。采用受试者工作特征(ROC)曲线评估血清GFAP、MCP-1、血氨水平对重型肝炎并发HE患者的诊断价值。结果:并发HE组患者血清GFAP水平明显低于未并发HE组(P<0.05),MCP-1和血氨水平明显高于未并发HE组(P<0.05)。HE 0~1级、HE 2级、HE 3~4级患者血清GFAP水平依次降低(P<0.05),MCP-1、血氨水平依次升高(P<0.05)。ROC曲线分析结果显示,血清GFAP、MCP-1和血氨单项诊断重型肝炎患者并发HE的曲线下面积(AUC)分别为0.779、0.811和0.897,最佳临界值分别为1.01μg/ml、139.05 ng/ml和151.55μmol/L,敏感性分别为69.0%、60.3%和69.0%,特异性分别为75.9%、89.7%和94.8%;3项指标联合检测诊断重型肝炎并发HE患者的AUC为0.972,敏感性为94.8%,特异性为87.9%;3项指标联合检测诊断重型肝炎并发早期HE(HE 0~1级)患者的AUC为0.864,敏感性为80.8%,特异性为81.0%。结论:血清GFAP、MCP-1联合血氨检测对重型肝炎并发HE有较高的诊断价值。

Objective:To explore the diagnostic values of serum glial fibrillary acidic protein(GFAP),monocyte chemoattractant protein-1(MCP-1)and blood ammonia levels in patients with severe hepatitis complicated with hepatic encephalopathy(HE).Methods:Detect serum GFAP,MCP-1 level and serum blood level in 58 patients with severe hepatitis complicated with HE(HE group,including 26 patients with HE grade 0~1,19 patients with HE grade 2 and 13 patients with HE grade~4)and 58 patients with severe hepatitis without HE(HE group).Using the receiver-operating characteristic(ROC)curve to evaluate serum GFAP,MCP-1,blood ammonia level value to the diagnosis of patients with severe hepatitis complicated with HE.Results:Compared with the non-HE group,the serum GFAP level in the HE group was significantly lower(P<0.05),while the levels of MCP-1 and blood ammonia increased significantly(P<0.05).With the increase of HE series,the level of serum GFAP in patients with severe hepatitis complicated with HE decreased significantly(P<0.05),and the levels of MCP-1 and blood ammonia increased significantly(P<0.05).The area under the ROC curve of serum GFAP,MCP-1 and blood ammonia expression in patients with severe hepatitis complicated with HE was 0.779,0.811 and 0.897 respectively,the truncation value was 1.01μg/ml,139.05 ng/mL and 151.55μmol/L respectively,the sensitivity was 69.0%,60.3%and 69.0%respectively,the specificity was 75.9%,89.7%and 94.8%respectively.The area under ROC curve of the combined detection in patients with severe hepatitis complicated with HE was 0.972,the sensitivity was 94.8%,the specificity was 87.9%.The area under ROC curve of the combined detection in patients with severe hepatitis complicated with HE(grade 0~1)was 0.864,the sensitivity was 80.8%,the specificity was 81.0%.Conclusion:The levels of serum GFAP and MCP-1 combined with serum ammonia detection has high diagnostic value for HE complicated by severe hepatitis.