血清免疫球蛋白诊断乙型肝炎相关肝硬化的价值

目的评价血清免疫球蛋白G（1gG）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）诊断肝硬化的价值。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，非肝硬化患者144例。统计分析采用SPSS12．0软件；血清IgG、IgA和IgM水平诊断肝硬化的评价采片jROC曲线法。结果血清IgG、IgA和IgM水平诊断肝硬化的ROC曲线下面积分别为0．764（95％CI=0．670～0．857）、0．670（95％CI=0．566～0．773）和0．557（95％CI=0．449～0．664）。血清IgG和IgA水平诊断肝硬化的最佳截断值分别为16．85g／L和1．89g／L，其诊断肝硬化的灵敏度、特异度、阳性预测值、阴性预测值、准确度、Youden指数分别为0．821和1．000、0．660和0．285、0．319和0．214、0．950和1．000、0．686和0．401、0．481和0．285。结论血清IgG水平可作为否定诊断肝硬化的参考指标；虽然血清IgA水平也有一定否定诊断肝硬化的价值，但其可靠性很差；血清IgM水平没有诊断肝硬化的意义。

Practical value of serum immunoglobulins for diagnosing hepatitis B associated cirrhosis

Objective To appraise the practical value of serum immunoglobulin G （IgG）, immunoglobulin A （IgA） and immunoglobulin M （IgM） for diagnosing hepatitis B associated cirrhosis. Methods In 172 patients with chronic hepatitis B, 28 patients and 144 patients were diagnosed as cirrhosis and non-cirrhosis respectively by pathological method. SPSS 12.0 was used for statistical analyses. Serum IgG, IgA and IgM levels for diagnosing cirrhosis were appraised with ROC curve. Results The areas under ROC curve of serum IgG, IgA and IgM levels for diagnosing cirrhosis were 0.764（95% CI =0.670 -0.857） , 0.670（95% CI=0.566-0.773） and0.557（95% CI=0.449 -0.664）. The optimal cut-offs of serum IgG and IgA levels for diagnosing cirrhosis were 16.85 g/L and 1.89 g/L respectively. The sensitivities, speeifieities, positive predictive values, negative predictive values, accuracies, Youden＇ s indexes of which were 0.821 and 1.000, 0.660 and 0.285, 0. 319 and 0.214, 0.950 and 1.000, 0.686 and 0.401, 0.481 and 0. 285. Conclusion Serum IgG levels can be applied as an index for diagnosing negatively cirrhosis, serum IgA levels can also be applied as an index for diagnosing negatively cirrhosis with very doubtful reliability, serum IgM has no practical value for diagnosing cirrhosis.