慢性乙型肝炎患者血清生物化学指标对肝组织炎症程度的评估价值

目的 利用临床生物化学指标建立初步判定慢性乙型肝炎患者肝组织炎症、坏死程度的评分系统.方法 统计分析255例慢性乙型肝炎患者临床和病理资料,从19个生物化学指标中选出5个参与评分,按不同检测值分为0～4分,总分用于判定肝组织炎症和坏死程度.结果 ALT、AST、胆碱酯酶、γ-谷氨酰转肽酶和总胆汁酸被纳入评分系统,以总分≤5分判定为炎症分级G<2,5分以上判定为炎症分级G≥2,判定结果与肝组织炎症、坏死程度的符合率为82.8%,以此系统筛选G≥2患者的敏感性为83.8%,特异性为81.2%,阳性预测值为88.6%,评分系统应用于大于12岁患者的符合率、敏感性、特异性、阳性预测值分别达到86.7%、88.0%、84.7%和90.6%.结论 建立的评分系统能初步评估慢性乙型肝炎患者,尤其是>12岁患者的肝组织炎症坏死程度.

Estimation of liver inflammation and necrosis in patients with chronic hepatitis B through different biochemical items

Objective To establish a new grading system to evaluate liver inflammation and necrosis in patients with chronic hepatitis B through clinical biochemical assays.Methods Clinical and pathological data were collected from 255 cases with chronic hepatitis B.19 biochemical items were analyzed and 5 items were selected for our grading system.Each of the five items was scored 0 to 4 based on the different values.The extent of liver inflammation and necrosis was evaluated according to the total score.Results ALT,AST,ChE,GGT and TBA were selected for our grading system.The grade of liver inflammation and necrosis was considered less than 2.0 if total score lower than 6,and higher grade was considered with higher total score.The estimated results shared an identity of 82.8% with the real grades of liver inflammation and necrosis.When this grading system was applied to patients with liver inflammation and necrosis equal to or higher than grade 2.0,it exhibited a sensitivity of 83.8%,a specificity of 81.2%,a positive prediction value of 88.6%,a negative prediction value of 74.2% in all cases,and 88.0%,84.7%,90.6%,82.4% respectively in patients older than 12 years.Conclusion Our data suggest that the grading system can be used to evaluate the extent of liver inflammation and necrosis in patients with chronic hepatitis B.