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目的探讨不同的检测项目组合模式对慢性活动性乙型肝炎患者肝脏损伤的诊断价值。方法检测慢性活动性乙型肝炎患者血清谷丙转氨酶(ALT)、前白蛋白(PAB)、总胆汁酸(TBA)、超敏C-反应蛋白(hs-CRP)及D-二聚体(DD)含量并进行分组研究。结果血清ALT、TBA及DD在正常对照组与患者组间差异有统计学意义,且随着肝脏炎症程度的增加而逐渐升高,PAB则正好相反。血清hs-CRP在肝脏炎症分级为G1和G2级时的含量明显高于对照组,但在G3及G4级其含量降至正常对照组水平。将检测项目进行不同的组合并研究组合后检测结果对肝脏损伤的诊断价值,表明随着组合项目的增多,对肝脏损伤的诊断特异性增加,灵敏度有所下降,但PAB+TBA、PAB+DD、TBA+DD三种组合模式,特别是TBA+DD组合模式在检测灵敏度下降不明显的情况下能显著增加检测的特异性。结论合理选择项目组合对提高慢性活动性乙型肝炎肝脏损伤诊断的特异性具有一定的帮助。
Objective To investigate the diagnostic value of different combinations of test items on liver damage in patients with chronic active hepatitis B. Methods Serum alanine aminotransferase (ALT), prealbumin (PAB), total bile acid (TBA), hs-CRP and D-dimer were measured in patients with chronic active hepatitis B ) Content and group study. Results The serum levels of ALT, TBA and DD were significantly different between the normal control group and the patient group, and gradually increased with the increase of liver inflammation, while the PAB was the opposite. Serum hs-CRP levels in the liver inflammation grading G1 and G2 levels were significantly higher than the control group, but at the G3 and G4 levels its levels fell to the normal control group. The combination of test items and study of the combination of test results on the diagnosis of liver damage, indicating that with the combination of items increased diagnostic specificity of liver injury increased, the sensitivity decreased, but PAB + TBA, PAB + DD , TBA + DD three combination modes, especially the TBA + DD combination mode can significantly increase the specificity of the detection under the condition that the detection sensitivity is not obviously decreased. Conclusion The rational selection of the project portfolio is helpful to improve the specificity of diagnosis of chronic active hepatitis B liver damage.