慢性肝炎临床生化指标与病理分级相关分析

Comparison of Biochemcal Markers and Pathohistological Grading of Chronic Hepatitis

目的 研究肝功能指数 (AAPea指数 )在慢性肝炎分度诊断中的意义。方法 对 80 0例慢性肝炎肝穿病例临床生化指标通过差别分析筛选 ,测定血清A/G、AST、PA、EP、与ALB与病理分级相关性 ,根据这些指标量化打分 ,计算肝功能指数 (AAPea指数 ) ,并进一步研究其与肝组织病理损伤的关系 ,通过受试者特征工作曲线 (SOCC)确定cut -off值。结果 AAPea指数与慢性肝炎肝组织炎症活动程度及纤维化程度相关系数分别为 0 5 5 9、0 5 45 (P <0 0 0 0 1) ,与病理分度相关系数为 0 5 2 9(P <0 0 0 0 1)。轻、重度cut-off值分别为小于 12分、大于 2 4分时 ,敏感性、特异性分别 0 818、0 789和 0 3 82、0 3 94,中度在 12～ 2 4分间敏感性、特异性为0 5 0 4、0 5 43 ,本临床与病理符合率比单项指标判定为高。结论 肝功能指数 (AAPea指数 )评估慢性肝炎组织炎症活动程度及纤维化程度有意义 ,但对重度评估效果较差 ,值得进一步研究。

Objective To investigate the value of liver function indexes(AApea index) in evaluation of chronic hepatitis pathohistological grading.Methods The biochemical tests and histopathological data of 800 patients who underwent liver biopsy with step discriminant screen,serum ALT,TBil,AST,A/G,EP,PA,and ALB were assayed.A liver function index(AApea index) was calculated according to these biochemical tests,and compared with histopathological data in each patient.Results The AApea index had a significantly positive correlation with the histological inflammatory grading,fibrosis staging,and severe degree(correlation coefficient were 0 559,0 545 and 0 529 respectively,P<0 0001).Subjects operating characteristic curve(SOCC) showed that the best cut-off values of low grade and for advanced hepatitis were under 12 and over 24 scores,respectively;Their sensitivity and spcificity were 0 818,0 789 and 0 382,0 394,respectively.If moderate hepatitis score was that from 13 to 23,the sensitivity and spcificity were 0 504 and 0 543 respectively.Evaluating efficiency with AApea index was better than with single biochemical mark.Conclusion AApea index is valuable in estimating the severity of CH,but the evaluating efficiency is poor for advanced CH.So that,it requires observation further.