自身抗体与血浆炎症因子联合检测对肝硬化合并肝功能衰竭的诊断价值

目的 探讨和分析自身抗体、血浆炎症指标联合检测在肝硬化合并肝功能衰竭患者中的诊断价值.方法 选取2014年10月至2016年8月我院收治的62例肝硬化合并肝功能衰竭患者作为试验组,并选取同一时段于我院治疗的42例慢性肝炎患者作为疾病对照组,以及42例健康体检志愿者作为健康对照组.分别采用电化学发光法(ECLIA)检测3组的血清PCT水平,采用免疫散射比浊法(INA)检测血清CRP水平,以及酶联免疫标记法(ELISA)检测其血清AMA-M2和抗-gp210水平.结果 试验组血清PCT、CRP表达水平与疾病对照组和健康对照组相比,差异具有统计学意义(P<0.05);而对疾病对照组和健康对照组的血清PCT、CRP表达水平比较发现,同样呈现显著性差异(P<0.05);试验组血清AMA-M2、抗-gp210、PCT及CRP检测的阳性率均明显高于两对照组,差异有统计学意义(P<0.05);血清AMA-M2、抗-gp210、PCT及CRP检测的灵敏度分别为82.3%、71.0%、74.1%和58.1%,特异性分别为91.7%、80.9%、76.2%和67.9%,准确度分别为76.7%、79.5%、78.8%和72.6%,而四者联合检测的灵敏度、特异度及准确度分别为43.5%、96.9%和92.7%,与各指标单独检测相比,灵敏度下降、特异度和准确度提升,差异有统计学意义(P<0.05).此外AMA、抗-gp210和PCT或CRP三者联合检测同样会显著降低灵敏度,提升特异性,但准确度变化不大.结论 AMA-M2、抗-gp210、PCT及CRP单独检测在肝硬化合并肝功能衰竭的诊断中具有一定的价值,但也存在着误诊及漏诊的情况,而自身抗体与血浆炎症指标的联合检测可有效提高检测特异度及准确度,增加疾病的检测率,值得临床推广运用.

Diagnostic Value of Autoantibodies Combined with Plasma Inflammatory Markers in Patients with Liver Cirrhosis and Hepatic Failure

Objective To investigate and analyze the diagnostic value of combined detection of autoantibodies and plasma inflammatory markers in patients with liver cirrhosis and hepatic failure.Methods From October 2014 to August 2016 in our hospital 62 cases of liver cirrhosis and liver failure patients as experimental group, 42 cases of chronic hepatitis B patients and select the same period in our hospital treatment of diseases as control group, and 42 healthy volunteers as healthy control group.Respectively by electrochemiluminescence (ECLIA) detection of serum PCT levels in the 3 groups, by immune nephelometry (INA) to detect the level of serum CRP, and enzyme-linked immunosorbent assay (ELISA) detection of serum AMA-M2 and anti-gp210 levels.Results The serum PCT and the expression level of CRP in experimental group and disease control group compared with the healthy control group, the difference was statistically significant (P<0.05);and comparison of disease control group and healthy control group of serum PCT, CRP expression levels also showed significant differences (P<0.05);the positive rate of serum AMA-M2 and anti-gp210 test group PCT and CRP detection were significantly higher than the control group two, the difference was statistically significant (P<0.05);the sensitivity of serum AMA-M2, anti-gp210, PCT and CRP detection were 82.3%, 71.0%,74.1% and 58.1%, the specificity was 91.7%, 80.9%, 76.2% and 67.9%, the accuracy was 76.7%, 79.5%, 78.8% and 72.6% respectively, and the four combined detection sensitivity, specificity and accuracy were 43.5%, 96.9% and 92.7%, and each index detection alone compared with decreased sensitivity, specificity and accuracy The difference was statistically significant (P<0.05).In addition, AMA, anti-gp210 and PCT or CRP three joint detection can also significantly reduce sensitivity and enhance specificity, but accuracy is not changed.Conclusion AMA-M2, anti-gp210, PCT and CRP alone has a certain diagnostic value of combined detection of hepatic failure in patients with liver cirrhosis, but also exist misdiagnosis and missed diagnosis of the situation, and the combined detection of inflammatory markers and plasma autoantibodies can effectively improve the specificity and accuracy, increase the disease detection rate, it is worthy of clinical promote the use of.