血清铜蓝蛋白联合透明质酸检测在肝纤维化患者诊断中的应用

目的探讨血清铜蓝蛋白(CP)联合透明质酸(HA)检测在肝纤维化患者诊断中的应用前景。方法选取2015年1月至2018年12月本院收治的疑似肝纤维化患者226例为研究对象,对患者的CP、HA水平进行联合检测,根据各项指标检测水平对患者做出诊断,并与金标准诊断方法肝穿刺活检结果进行对比。对CP、HA单独检测和联合检测的诊断结果进行统计对比,并对各组检查方法的灵敏度、特异度、假阳性率、假阴性率、准确度等进行统计对比,比较不同检查方法在不同肝纤维化分级患者中的诊断正确率。结果 226例患者中金标准诊断201例(88.94%)为肝纤维化,CP单独检测检出154例(68.14%),HA单独检测检出143例(63.27%),CP+HA联合检测检出195例(86.28%)。经Kappa一致性检验分析CP+HA联合检测与金标准结果有高度一致性,CP、HA单独检测与金标准结果为中等一致性。CP+HA联合检测的灵敏度、特异度、准确度均高于CP、HA单独检测,方法间比较差异有统计学意义(χ²=11.602、55.959、78.047,P=0.003、0.039、0.002)。在不同分级肝纤维化患者中,CP+HA联合检测在Ⅰ级、Ⅱ级纤维化检出率高于CP、HA单独检测,方法间比较差异有统计学意义(χ2=9.432、8.324,P=0.007、0.010)。结论 CP联合HA检测在肝纤维化患者诊断中应用情况良好,有较高的诊断正确率,且对症状程度较轻的肝纤维化患者有较高的检出率,可作为肝纤维化诊断检查的主要手段加以推广应用。

Application of serum ceruloplasmin combined with hyaluronic acid in diagnosis of hepatic fibrosis

Objective To discuss the application of serum ceruloplasmin(CP) combined with hyaluronic acid(HA) in the diagnosis of hepatic fibrosis. Methods A total of 226 patients with suspected hepatic fibrosis admitted to our hospital from January 2015 to January 2018 were enrolled. The levels of CP and HA were detected jointly. The diagnostic results were made according to the detected levels of various indicators, and compared with the results of liver biopsy, the gold standard diagnostic method. The diagnostic results of CP, HA and CP+HA were compared, and the sensitivity, specificity, false positive rate, false negative rate and accuracy of each group were compared. The diagnostic accuracy of different methods in patients with different grades of liver fibrosis were compared. Results In the 226 patients, 201(88.94%) were diagnosed as hepatic fibrosis by gold standard, CP alone detected 154(68.14%) cases, HA alone detected 143(63.27%) cases, the combined detection of CP and HA detected 195(86.28%) cases. According to Kappa consistency test, the results of CP+HA combined detection and gold standard were highly consistent, and the results of CP alone and HA alone detections and gold standard were moderately consistent. The sensitivity, specificity and accuracy of the combined detection of CP and HA were higher than those of CP and HA alone, and there were significant differences among the methods(all P<0.05). In patients with different grades of hepatic fibrosis, the detection rates of CP+HA combined detection in grade I and II fibrosis were higher than those of CP alone and HA alone detection, and there were significant differences among the methods(all P<0.05). Conclusion Serum ceruloplasmin combined with hyaluronic acid is well applicable for the diagnosis of hepatic fibrosis, with a high diagnostic accuracy and a high detection rate in patients with mild symptoms of hepatic fibrosis, which can be widely used as the main means of diagnosis and examination of hepatic fibrosis.