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1.
Logistic回归分析评价血清免疫球蛋白预测乙型肝炎相关肝硬化 总被引:8,自引:0,他引:8
目的 探讨血清免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)对乙型肝炎相关肝硬化的诊断价值.方法 慢性乙型肝炎172例,其中病理诊断为肝硬化的患者28例,非肝硬化的患者144例.血清免疫球蛋白采用免疫透射比浊法测定.统计分析采用SPSS 12.0软件.肝硬化与非肝硬化患者之间血清IgG、IgA和IgM水平的比较采用两独市样本t检验;血清IgG、IgA和IgM水平诊断肝硬化的评价采用二分类Logistic回归分析.结果 肝硬化患荇血清IgG和IgA水平显著高于非肝硬化患者(t=4.702和3.034,P=0.000和0.003),血清IgM水平相近于非肝硬化患者(t=0.132,P=0.895).血清免疫球蛋白中,只有IgG符合Logistic回归分析纳入自变量标准(P<0.05).基于血清IgG建立的Logistic同归模型预测肝硬化的灵敏度、特异度、阻性预测值、阴性预测值、准确度分别为0.107、0.986,0.600、0.850、0.843.结论 血清IgG可作为预测乙型肝炎相关肝硬化的一项重要指标. 相似文献
2.
目的构建诊断慢性肝炎病理分级(G)和分期(S)的数学模型,评价血清免疫球蛋白(IgG、IgA和IgM)判别慢性肝炎病理分级和分期的价值。方法慢性乙型肝炎172例,肝穿刺活检标本进行病理分级和分期;免疫透射比浊法测定血清免疫球蛋白。以病理分级和分期作为因变量,血清IgG、IgA和IgM作为自变量,用Bayes逐步判别分析构建判别函数。结果血清IgG和IgA水平与病理分级呈显著正相关(r=0.324,P=0.000和r=0.468,P=0.000),与病理分期呈显著正相关(r=0.201.P=0.008和r=0.254,P=0.001);血清IgM水平与病理分级和分期均无显著相关性(r=0.046,P=0.547和r=0.104,P=0.176)。符合模型纳入变量、进入判别模型的指标只有血清IgG,该模型判别病理分级G1、G2、G3、G4的正确率分别为66.67%、14.44%、30.61%、66.67%,总正确率29.07%;判别病理分期S0、S1、S2、S3、S4的正确率分别为50.00%、2.94%、13.95%、27.12%、50.00%,总正确率60.71%。结论血清IgG符合该数学模型纳入变量,对判别肝脏病理分级和分期有一定价值。 相似文献
3.
目的探讨血清补体C3和C4预测慢性乙型肝炎肝组织炎症活动度和纤维化程度的价值。方法416例经肝组织病理学检查的慢性乙型肝炎患者人选本研究。血清补体C3和C4采用Beckman—Coulter Immage800免疫化学系统及其配套试剂测定。结果血清补体C3和C4预测显著炎症(≥G2)、中度炎症(≥G3)、重度炎症(=G4)的ROC曲线下面积分别为0.602(95%CI:0.545—0.659)和0.550(95%CI:0.489—0.611)、0.620(95%CI:0.559~0.681)和0.606(95%CI:0.547~0.666)、0.803(95%cI:0.670—0.937)和0.654(95%CI:0.486~0.823);预测显著纤维化(≥S2)、严重纤维化(≥S3)、肝硬化(=S4)的ROC曲线下面积分别为0.590(95%CI:0.531~0.649)和0.582(95%CI:0.519~0.644)、0.665(95%CI:0.612~0.718)和0.655(95%CI:0.602~0.707)、0.669(95%CI:0.603—0.736)和0.670(95%CI:0.607~0.734)。血清补体C3和C4预测重度炎症和肝硬化的最佳截断值分别为≤0.58g/L和≤0.12g/L,其对应的灵敏度、特异度、准确度分别为0.750和0.480、0.797和0.792、0.796和0.719。结论血清补体C3和C4分别对慢性乙型肝炎肝组织重度炎症和肝硬化有一定的预测价值。 相似文献
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目的 探讨老年脂肪肝病人血清免疫球蛋白(Ig)水平与肝纤维化的关系。方法 采用免疫散射比浊法检测108例老年脂肪肝患者血清IgA、IgG、IgM含量及采用放射免疫吸附试验(RIA)测定血清透明质酸(HA)、Ⅳ型前胶原肽(IVC)及层黏连蛋白(LN)水平,并分析其相关性。结果 老年脂肪肝患者血清IgA、IgG、IgM含量明显高于对照组(P〈0.01),肝纤维化指标HA、IVC、LN水平明显高于对照组(P〈0.01),而且患者血清IgA、IgG、IgM与HA、IVC、LN之间呈显著正相关(P〈0.01或P〈0.05)。结论 老年脂肪肝有较为明显的肝纤维化倾向。检测其血清IgA、IgG、IgM与HA、IVC、LN含量,对于脂肪肝纤维化的诊断及评估预后具有重要的临床意义。 相似文献
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目的探讨肝硬化患者中糖尿病与原发性肝癌(primary hepatic carcinoma,PHC)发生的相关性。方法对2001年12月-2008年12月解放军第jo二医院诊断为肝炎肝硬化、酒精性肝硬化患者22132例(合并PHC患者6169例为病例组)进行病例对照研究,分析肝硬化患者中糖尿病与PHC的发生有无相关性,并按病因(包括乙型肝炎肝硬化、丙型肝炎肝硬化和酒精性肝硬化)分层分析其相关程度。结果在肝硬化患者中,合并糖尿病患者发生PHC的OR值为1.851(95%CI,1.693~2.023,X^2=184.55,P=0.000),其中乙型肝炎肝硬化、内型肝炎肝硬化和酒精性肝硬化组的OR值分别为1.850(95%CI,1.666~2.050,X2=137.52,P=0.000)、2.238(95%CI,1.738~2.882,X2=38.97,P=-0.000)和1.935(95%CI,1.472~2.567,X^2=20.89,P=0.006)。结论肝硬化患者合并糖尿病可以增加发牛PHC的胍险,在丙型肝炎肝硬化患者最为明显。 相似文献
6.
目的比较自身免疫性肝病中自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)及其重叠综合征(0s)的临床、血清学及病理学特点,并检测血清及肝组织中IgM及IgG的比例,评估其对AIH及PBC的鉴别诊断意义。方法回顾性分析106例自身免疫性肝病病例,采用ELISA法测定三组外周血IgM和IgG水平,免疫组化法检测并比较其肝组织中炎性细胞IgM及IgG的表达情况。结果比较AIH、PBC及0s患者血清中IgM和IgG水平及肝组织中的IgM和IgG阳染炎性细胞比例后发现:PBC组IgM/IgG比值较AIH组高(0=9.584,P〈0.05);在肝组织汇管区,AIH组以IgM+/IgG+〈1者为主,占66.7%(22/33);PBC组以IgM+/IgG+≥1者为主,占100%(10/10),其中tgM+/IgG+=1者占50%;OS组IgM+/IgG+≥1者,占84.6%(11/13)。PBC组与AIH组IgM+/IgG+比较,x^2=11.113,P〈0.05;OS组与AIH组比较,)(2=7.881,P〈0.05。结论血清及肝组织中IgM/IgG比值对AIH、PBC及其OS的鉴别诊断具有一定帮助。 相似文献
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目的观察HBeAg阳性慢性乙型肝炎和乙型肝炎肝硬化患者经替比夫定抗病毒治疗后血清免疫球蛋白IgG、IgA、IgM和补体C3、C4的变化,探讨替比夫定治疗对于患者体液免疫功能的影响。方法选择35例HBeAg阳性慢性乙型肝炎和22例乙型肝炎肝硬化患者,给予替比夫定抗病毒治疗,于治疗前和治疗后3个月、6个月,采用免疫透视比浊法检测血清免疫球蛋白IgG、IgA、IgM和补体C3、C4。结果在治疗前,慢性乙型肝炎患者血清IgG水平为(16.21±2.54) mg/L,显著低于肝硬化患者的[(19.42±2.95) mg/L,P<0.05];在治疗6个月时,肝硬化患者血清IgA水平为(1.41±0.18) mg/L,显著高于慢性乙型肝炎患者的[(1.26±0.17) mg/L,P<0.05];在其他各时间点比较,两组患者血清免疫球蛋白和补体水平无显著性相差(P>0.05)。结论HBeAg阳性慢性乙型肝炎和乙型肝炎肝硬化患者经替比夫定抗病毒治疗后机体体液免疫功能有一定程度的恢复。 相似文献
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目的:探讨免疫球蛋白A(IgA)在成人癫痫发病机制中的作用。方法选择新诊断成人癫痫患者112例,其中非症状性癫痫( A组)及症状性癫痫( B组)各56例,另选体检健康者56例作为对照组。采用胶乳增强免疫比浊法检测3组血清IgA、IgG、IgM、C3、C4水平。结果 A组血清IgA水平明显低于B组及对照组( P均<0.05);3组血清IgG、IgM、C3、C4水平两两比较均无统计学差异(P均>0.05)。结论 IgA降低可能为成人非症状性癫痫的血生化标志之一,其可能参与了成人癫痫的发病机制。 相似文献
9.
辽宁庄河地区居民血清胃蛋白酶原含量检测分析 总被引:5,自引:0,他引:5
目的 检测辽宁庄河居民血清胃蛋白酶原(PG)含量,以明确其基本人群分布特征,并探讨相关影响因素。方法 利用酶联免疫吸附试验(ELISA)方法对辽宁庄河地区6990名居民进行血清PGI、PGⅡ含量检测,并计算PGI/Ⅱ比值;利用胃镜及胃黏膜组织病理学检查进行胃疾病诊断;利用ELISA法检测血清幽门螺杆菌(Hp)IgG抗体滴度。结果 辽宁庄河地区居民血清PGⅠ、PGⅡ及PGI/Ⅱ中位值分别为86.9μ/L、10.6μg/L和8.1。男性血清PGⅠ、PGⅡ(95.2μg/L、12.1μ/L)显著高于女性(79.7μg/L、9.4μg/L;P=0.000),PGⅠ/Ⅱ(7.9)显著低于后者(8.3,P=0.000)。PGI/Ⅱ随年龄增高呈阶段性显著降低。PGⅠ/Ⅱ在胃黏膜由基本正常(10.4)向非萎缩性病变(8.8)、萎缩性病变(6.6)转变过程中呈显著性降低。Hp感染者血清PGⅠ、PGⅡ(88.7μg/L,11.4μg/L)显著高于非感染者(81.4μg/L,8.4μg/L;P=0.000),PGⅠ/Ⅱ(7.7)显著低于后者(9.6,P=0.000)。以PGⅠ/Ⅱ为指标筛选胃黏膜萎缩性病变,ROC曲线下面积为0.622,最适临界值为6.9,灵敏度53.2%,特异度67.5%。多因素Logistic回归分析,男性(OR:1.151,95%CI:1.042~1.272,P=0.006)、年龄≥61岁(OR:1.358,95%CJ:1.188~1.553,P=0.000)、萎缩性病变(OR:2.075,95%CI:1.870~2.302,P=0.000)及Hp感染(OR:1.546,95%CI:1.368~1.748,P=0.000)是明显影响PGⅠ/Ⅱ水平的因素。结论 辽宁庄河居民血清PG水平呈明显偏态分布,受性别、年龄因素影响,与胃疾病和Hp感染密切相关。PGⅠ/Ⅱ较之PGⅠ和PGⅡ,更适用于胃疾病筛查。 相似文献
10.
目的 观察新生儿缺氧缺血性脑病(HIE)患儿外周血淋巴细胞免疫分型及血清免疫球蛋白水平变化,并探讨其临床意义.方法 选取60例HIE患儿为HIE组,其中轻度32例,中重度28例.另选同期健康足月新生儿30例作为对照组.采用流式细胞术测定两组患儿外周血淋巴细胞免疫分型,采用免疫比浊法测定血清免疫球蛋白IgG、IgM、IgA水平.结果 HIE组患儿外周血IgM、IgA水平低于对照组(P均<0.01),且中重度患儿外周血IgM、IgA水平均低于轻度组及对照组(P均<0.05).结论 HIE患儿外周血IgM、IgA水平降低.血清免疫球蛋白可以作为HIE早期诊断、评价脑损伤程度及预后的参考指标. 相似文献
11.
目的探讨血清中免疫球蛋白和轻链测定以及血清蛋白电泳在肝病患者中的临床应用价值。方法用免疫散射比浊法在特定蛋白分析仪上检测92例肝病患者(包括急性肝炎患者28例、慢性肝炎患者33例、肝硬化患者31例)及45例健康者血清中免疫球蛋白IgG、IgA、IgM以及κ轻链和λ轻链的水平;用琼脂糖凝胶电泳法对所有样本进行血清蛋白电泳检测。结果与对照组相比,急性肝炎组以IgM升高为主,差异有统计学意义(P<0.05);两组κ轻链和λ轻链水平比较,差异无统计学意义(P>0.05)。急性肝炎组和肝硬化组IgG、IgA水平均高于对照组,差异有统计学意义(P<0.05);两组κ轻链和λ轻链水平分别与对照组比较,差异均有统计学意义(P<0.05)。血清蛋白电泳结果显示,急性肝炎组与对照组相比,两组γ区球蛋白含量比较,差异无统计学意义(P>0.05);慢性肝炎组和肝硬化组γ区球蛋白含量与对照组比较,差异有统计学意义(P<0.05)。结论血清中免疫球蛋白及其轻链的含量与肝脏疾病密切相关,慢性肝炎肝硬化患者血清蛋白电泳呈现典型的多克隆增殖图谱。血清蛋白电泳、免疫球蛋白和轻链水平的测定可作为肝脏功能监测的辅助指标。 相似文献
12.
Value of serum immunoglobulins in the diagnosis of liver disease 总被引:2,自引:0,他引:2
Serum immunoglobulins were determined in 145 consecutive patients with biopsy-proven steatosis, alcoholic hepatitis, alcoholic hepatitis with fibrosis, alcoholic hepatitis with cirrhosis, inactive cirrhosis, chronic active alcoholic hepatitis, chronic active hepatitis, primary biliary cirrhosis and nonspecific hepatitis. IgM was both a sensitive (90.5%) and specific (86.2%) marker for primary biliary cirrhosis, and mean IgM levels were higher in primary biliary cirrhosis than in other diagnostic categories (p less than 0.05). IgA levels were most commonly elevated in alcoholic liver disease (p less than 0.005). IgA detected 95% of alcoholic disease, but was poorly specific (41.1%). A trend of rising IgA with increasing severity of alcoholic injury was observed, but the differences were not significant. IgG was most commonly elevated in chronic active hepatitis and alcoholic hepatitis with cirrhosis, but the IgG values did not differ significantly from those found in other diagnostic categories. Our results substantiate assertions of a diagnostic sensitivity for elevated IgA in alcoholic liver disease and IgM in primary biliary cirrhosis. With the exception of IgM in primary biliary cirrhosis, however, serum immunoglobulins are not specific markers of liver histology. 相似文献
13.
Gonzàlez-Quintela A Alende MR Gamallo R Gonzàlez-Gil P López-Ben S Tomé S Otero E Torre JA 《Hepato-gastroenterology》2003,50(54):2121-2126
BACKGROUND/AIMS: Serum immunoglobulin concentrations are commonly elevated in patients with liver cirrhosis. Immunoglobulin class increase may vary depending on the cause of liver disease. Hepatitis C virus is, together with alcohol, a leading cause of chronic liver disease. The present study aimed to evaluate serum IgG, IgA and IgM levels in chronic hepatitis C. Results were compared with those of patients with non-cirrhotic alcoholic liver disease and healthy controls. Special attention was given to cases with minimal liver disease, as an approach to evaluate if the causing agent, independently of liver damage, influences serum immunoglobulin levels. METHODOLOGY: A total of 274 patients with histologically-proven chronic hepatitis C, 121 alcoholics with non-cirrhotic liver disease (steatosis or alcoholic hepatitis), and 75 healthy controls were studied. Serum IgG, IgA, and IgM were assayed by nephelometry. RESULTS: Serum IgG was increased in patients with chronic hepatitis C with respect to both alcoholics (p < 0.001) and healthy controls (p < 0.001). IgG levels were similar in alcoholics and in controls. IgA was increased in patients with non-cirrhotic alcoholic liver disease with respect to both chronic hepatitis C patients (p < 0.001) and controls (p < 0.001). IgA values were similar in subjects with chronic hepatitis C and controls. Selective IgG or IgA alteration was present in cases with minimal liver disease (chronic hepatitis C with a Knodell index equal or lower than 3, and alcoholics with liver steatosis, respectively). CONCLUSIONS: Hepatitis C virus and alcohol are linked to a selective increase of serum IgG and IgA, respectively, even in cases with mild or minimal liver disease. 相似文献
14.
目的 探讨血清乙型肝炎表面抗原(HBsAg)水平和乙型肝炎病毒DNA(HBV DNA)载量预测慢性乙型肝炎(CHB)肝组织炎症活动度和纤维化程度的效能.方法 472例经肝组织活检的CHB患者入选本研究,其中HBeAg阳性279例,HBeAg阴性193例.肝组织病理学分级≥G2、≥G3、≥G4分别被定义为显著炎症、严重炎症和进展期炎症,病理学分期≥S2、≥S3和≥S4分别被定义为显著纤维化、严重纤维化和进展期纤维化.结果 HBeAg阳性患者血清HBsAg在G1与G3、G2与G3、S1与S4、S2与S4、S3与S4之间的差异均有统计学意义(P均<0.05),血清HBV DNA载量在S1与S4、S2与S4、S3与S4之间的差异均有统计学意义(P均<0.05);HBeAg阴性患者血清HBsAg在肝组织不同病理学分级和分期之间的差异无统计学意义(P>0.05),血清HBV DNA载量在G1与G3、S1与S2、S1与S3、S1与S4之间的差异均有统计学意义(P均<0.05).HBeAg阳性患者血清HBsAg诊断严重炎症和进展期纤维化的ROC曲线下面积分别为0.711 (95% CI:0.647~0.775)和0.765(95% CI:0.707~0.823),血清HBV DNA诊断严重炎症和进展期纤维化的ROC曲线下面积分别为0.589(95% CI:0.519 ~0.659)和0.700(95% CI:0.632 ~0.769);HBeAg阴性患者血清HBV DNA诊断非显著炎症和非显著纤维化的ROC曲线下面积分别为0.644(95% CI:0.565 ~0.723)和0.684(95% CI:0.606~0.761).结论 血清HBsAg对HBeAg阳性患者肝组织严重炎症和进展期纤维化有一定的预测价值;血清HBV DNA对HBeAg阳性患者肝组织严重炎症和进展期纤维化和对HBeAg阴性患者肝组织非显著炎症和非显著纤维化有一定的预测价值. 相似文献
15.
目的:探讨红细胞输注无效的慢性病患者体内血清免疫球蛋白IgG、IgA、IgM以及补体C3、C4的含量与输血效果之间的关系。方法:采用酶联免疫法测定慢性再生障碍性贫血(CAA)、肝癌和肺癌患者中试验组和对照组输血前、后血清IgG、IgA、IgM以及补体C3、C4的含量。结果:试验组、对照组各26名,研究对象为CAA患者、肝癌和肺癌患者,CAA患者试验组和肝癌患者试验组输血后5d的IgG和IgA有升高表现(P〈0.05),肺癌试验组患者的IgG和C3输血后与输血前相比较差别有统计学意义(P〈0.05),3组患者对照组输血前后免疫球蛋白以及补体的变化均差异无统计学意义(均P〉0.05)。结论:部分慢性病患者机体免疫系统的变化可能是导致红细胞输注效果不佳的原因之一,对于这部分患者,应该综合考虑输血治疗方法的利弊后再慎重选择。 相似文献
16.
目的探讨轻症和重症手足口病(hand,foot and mouth disease,HFMD)患儿血清免疫球蛋白变化与疾病进展的相关性。方法选择本院2013年6月住院的轻症和重症HFMD患儿369例,其中轻症组259例,重症组(含危重型)110例;以同期30名体检正常的健康儿童为对照组。采用免疫比浊法检测各组血清免疫球蛋白(IgA、IgG、IgM)和补体C3、C4表达水平。比较各组及重症组肠道病毒71型(enterovirus 71,EV71)感染和非EV71感染患儿、柯萨奇病毒A16(coxsackievirus A16,CoxA16)感染和EV71感染患儿的血清免疫球蛋白表达水平。结果与对照组相比,重症组IgG、IgA和IgM水平显著升高,轻症组IgM水平显著升高;与轻症组相比,重症组IgG和IgA水平显著升高;重症组EV71感染患儿IgM水平显著高于非EV71感染患儿,其IgG和IgM水平显著高于CoxA16感染患儿;各组间补体C3、C4水平比较差异均无统计学意义。结论 HFMD患儿血清免疫球蛋白表达水平存在变化,随着病情进展,血清免疫球蛋白表达水平变化更加显著。重症患儿血清免疫球蛋白表达水平显著高于轻症患儿,重症患儿中EV71感染者较CoxA16感染者血清免疫球蛋白表达水平变化更加显著。 相似文献
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Mingjian Lian Qianming Wang Shidong Chen Yuanyuan Yang Guolin Hong 《Journal of viral hepatitis》2023,30(5):437-447
The utility of measurement of serum immunoglobulin and complement in chronic hepatitis B (CHB) patients remains controversial. This study aimed to investigate the association of serum immunoglobulin and complement levels and liver fibrosis and inflammation stage in CHB patients. A total of 687 patients with CHB who underwent liver biopsy were enrolled. Serum immunoglobulin and complement were measured before liver biopsy, and liver pathological results were recorded. Associations of serum immunoglobulin and complement levels and liver fibrosis and inflammation stage were analysed. C3, C4, IgG and IgG1 had statistically significant differences among different fibrosis and different inflammation groups. Both C3 and C4 negatively correlated with fibrosis and inflammation stage, but IgG and IgG1 showed opposite results. C3, C4, IgG and IgG1 had statistical significance to predict ≥S2, ≥S3 and S4, and also had statistical significance to predict ≥G2, ≥G3 and G4. The area under curve (AUC) of the combination of C3, C4 and IgG (C3 + C4 + IgG) for predicting ≥S2, ≥S3 and S4 was 0.640 (95% CI: 0.603, 0.676), 0.674 (95% CI: 0.638, 0.709) and 0.744 (95% CI: 0.710, 0.776), respectively. The AUC of C3 + C4 + IgG for predicting ≥G2, ≥G3 and G4 was 0.723 (95% CI: 0.688, 0.756), 0.674 (95% CI: 0.638, 0.709) and 0.771 (95% CI: 0.738, 0.802), respectively. C3, C4, IgG and IgG1 are correlated with liver fibrosis and inflammation stage in CHB patients. C3, C4, IgG and IgG1 have diagnostic value for liver fibrosis and inflammation. C3 + C4 + IgG may improve diagnostic accuracy. 相似文献
18.
ABSTRACT— Patterns of intrahepatic immunoglobulin production were investigated by an in vitro biosynthetic labelling technique which measured the rate of Ig production in liver biopsy fragments. This technique depends on the incorporation of 3H-leucine into proteins synthesized by cells in the biopsy fragment and subsequently released into the culture medium, and precipitation of Ig with monospecific antisera. Intrahepatic Ig production was expressed as counts of radioactivity precipitated/g of liver tissue/24 h. Mean values were high in various inflammatory diseases of the liver, including alcoholic hepatitis (AH) (17 cases), IgG, 87.8, IgA, 105.6 and IgM, 14.7, chronic active hepatitis (CAH) (19 cases), IgG, 86.0, IgA, 56:1 and IgM, 12.6, and acute viral hepatitis (3 cases), IgG, 116.0, IgA, 61.0 and IgM, 32.0, but low in histologically normal livers (6 cases), IgG, 4.5, IgA, 4.8 and IgM, 4.7, alcoholic fatty liver (11 cases), IgG, 9.4, IgA, 11.4 and IgM, 7.1, and miscellaneous non-inflammatory conditions (10 cases), IgG, 8.7, IgA, 11.1 and IgM, 5.0. Photomicrographs were used to measure the density of plasma cells, expressed as cells/mm2 of liver biopsy tissue: mean counts were for AH 5.1, CAH 16.2 and normal liver 0.0. Intrahepatic Ig production in vitro did not correlate with the density of plasma cells in biopsy samples from cases of AH or CAH, nor with serum Ig levels. 相似文献