PGA指数和透明质酸在诊断慢性乙肝肝纤维化中的价值

目的：寻找一种简便实用的诊断慢性乙型肝炎纤维化的方法。方法：以78例经肝穿刺病理证实的慢性乙型肝炎为对象，测定并比较了由PT、GGT、ApoA1组成的PGA指数和HA、LN、PⅢP、C－IV与肝内纤维化程度(S)和炎症活动度（G）的关系。结果：（1）LN、PⅢP、C－IV在轻度慢性乙肝时无明显升高，在中度慢性乙肝时明显高于正常，但与轻度慢性乙肝无差异，而PGA指数和HA不仅在轻度慢性乙肝时显著升高，而且在轻中度间差异明显.因重度慢性乙肝和活动性肝硬化时，五项指标均显著增高。（2）在G2－4期，HA、LN、PⅢP、C－IV均明显高升，但在G1期，只有PGA指数高于正常，且各期间差异显著。（3）在S1－2期，只有PGA指数、HA、C－IV明显上升，但C－IV的上升幅度远低于PGA指数和HA。（4）加以PGA＞4．5或HA＞200μg／L作为判断临界值，则两者判断肝纤维化的敏感性均＞94％，精确性＞91％，特异性＞86％，如两者结合，则分别达到98．3％、95．2％和96．4％。结论：PGA指数和HA均是反映慢性乙型肝炎患者肝内纤维化程度的良好指标，两者联合检测则可达到最大的价值效益比。

The Values of PGA Index and HA in Diagnosis of Fibrosis in the Liver with Chronic Hepatitis B

Objective: To find a simple and practical method to diagnosis liver fibrosis in chronic hepatitis B (CH - B). Methods : In 78 cases with CH - B diagnosed by pathological histology, the relationship of the serum PGA index and HA, LN, Pb! P and C- IV with the stage of fibrosis (S) and the grade of inflammation (G) in the liver were compared. Results: `$LN, P b!P, C- IV did not raise in mild CH - B, but obviously increased in moderate CH - B compared with normal levels. There were no difference between mild and moderate CH - B for LN, Pb!P and C - IV. Otherwise, levels of PGA index and HA raised in mild CH - B, and there were difference between mild and moderate CH - B. a$ The levels of PGA index, HA, LN, Pb!P and C - IV were related to G2 - 4, but only PGA index was related to Gl and different between each grade of inflammation . b$ In S1 - 2, only PGA index, HA and C -IV were gone up, but the raising extent of C - IV was evidently lower than PGA index and HA. c$ The sensitivity, accuracy and specificity of PGA index >4.5or HA > 200?g/L were over 94% , 91% and 86% respectively. Combination with both of them could get to 98.3% in sensitivity, 95.2% in accuracy and 96. 4% in speciality. Conclusion: Both of PGA index and HA are helpful to dignose the stage of liver fibrosis with CH -B. Combination of them can get cost effect rate.