平均红细胞体积、红细胞分布宽度和血清淀粉样蛋白A监测慢性乙型肝炎进展的价值初探

doi:10.3969/j.issn.1673-8640.2020.11.016

摘要/Abstract

摘要：

目的探讨平均红细胞体积（MCV）、红细胞分布宽度（RDW）和血清淀粉样蛋白A（SAA）在监测慢性乙型肝炎（简称慢乙肝）疾病进展中的价值。方法通过比较50例慢乙肝患者（慢乙肝组）、56例慢乙肝后肝硬化患者（慢乙肝后肝硬化组）、92例慢乙肝后肝细胞癌患者（慢乙肝后肝细胞癌组）和39名体检健康者（正常对照组）MCV、RDW和SAA结果,用受试者工作特征（ROC）曲线分析3项指标对肝硬化及肝细胞癌的诊断效率,以及SAA水平与肝细胞癌患者病理特征的关系。结果慢乙肝组、慢乙肝后肝硬化组和慢乙肝后肝细胞癌组MCV、RDW、SAA均高于正常对照组（P<0.05）;慢乙肝后肝硬化组MCV和RDW高于慢乙肝组（P<0.05）;慢乙肝后肝细胞癌组SAA高于慢乙肝组（P<0.05）;慢乙肝后肝硬化组MCV和RDW高于慢乙肝后肝细胞癌组（P<0.05）,SAA低于慢乙肝后肝细胞癌组（P<0.05）。MCV、RDW、SAA及三者联合检测对诊断慢乙肝后肝硬化的敏感性和特异性分别为60.71%、80.68%,87.50%、69.32%,78.57%、71.59%,92.86%、72.73%。MCV、RDW和SAA对诊断慢乙肝后肝细胞癌的敏感性和特异性分别为40.22%、67.36%,58.70%、58.33%,53.26%、92.36%。SAA水平与肝细胞癌患者性别、肿瘤数目和血管侵犯等病理特征无明显相关性（P>0.05）,而与肿瘤大小及肝外转移有关（P<0.05）。结论 MCV、RDW和SAA是慢乙肝后肝硬化敏感的检测指标。SAA对诊断慢乙肝后肝细胞癌特异性强,且与肿瘤大小及肝外转移密切相关。3项指标联合检测在慢乙肝患者的日常随访、病情进展监测中具有实际应用价值。

关键词: 平均红细胞体积, 红细胞分布宽度, 血清淀粉样蛋白A, 慢性乙型肝炎

Abstract:

Objective To investigate the roles of mean corpuscular volume（MCV）,red blood cell distribution width（RDW）and serum amyloid A（SAA） in the progression of chronic hepatitis B. Methods Totally,198 patients with different liver diseases and 39 healthy subjects were enrolled. The patients included 50 cases of chronic hepatitis B,56 cases of liver cirrhosis and 92 cases of hepatocellular carcinoma. Receiver operating characteristic（ROC） curve were used to evaluate the diagnostic values of MCV,RDW and SAA in liver cirrhosis and hepatocellular carcinoma. The correlations between SAA and clinicopathological characteristics were analyzed. Results MCV,RDW and SAA in different liver disease groups were higher than those in healthy control group（P<0.05）,MCV and RDW in liver cirrhosis group were higher than those in chronic hepatitis B group（P<0.05）,SAA in hepatocellular carcinoma group was higher than that in chronic hepatitis B（P<0.05）,MCV and RDW in liver cirrhosis group were higher than those in hepatocellular carcinoma group（P<0.05）,and SAA was lower（P<0.05）. The sensitivities of MCV,RDW,SAA and the combined determination for the diagnosis of liver cirrhosis were 60.71%,87.50%,78.57% and 92.86%,respectively,and the specificities were 80.68%,69.32%,71.59% and 72.73%,respectively. The sensitivities and specificities of MCV,RDW and SAA in the diagnosis of hepatocellular carcinoma were 40.22%,67.36%;58.70%,58.33%;53.26%,92.36%,respectively. There was no correlation between SAA and patients' sex,tumor number and vascular invasion in hepatocellular carcinoma group（P>0.05）,while there were correlations between SAA and tumor size and extrahepatic metastasis（P<0.05）. Conclusions MCV,RDW and SAA are sensitive indicators of hepatitis B-related liver cirrhosis. SAA is highly specific for the diagnosis of hepatocellular carcinoma and is closely related to tumor size and extrahepatic metastasis. The determinations of MCV,RDW and SAA are fast and convenient,which have practical application value in the follow-up and monitoring progress of patients with chronic hepatitis B.

Key words: Mean corpuscular volume, Red blood cell distribution width, Serum amyloid A, Chronic hepatitis B

中图分类号:

R446.1

郭平, 庄丽花, 陈骊婷, 王剑飚, 吴建峰. 平均红细胞体积、红细胞分布宽度和血清淀粉样蛋白A监测慢性乙型肝炎进展的价值初探[J]. 检验医学, 2020, 35(11): 1153-1157.

GUO Ping, ZHUANG Lihua, CHEN Liting, WANG Jianbiao, WU Jianfeng. Roles of MCV,RDW and SAA in the progression of chronic hepatitis B[J]. Laboratory Medicine, 2020, 35(11): 1153-1157.

图/表 6

参考文献 20

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组别	MCV/fL	RDW/%	SAA/（mg/L）
正常对照组	91.2（89.2~93.0）	13.0（12.7~13.3）	4.9（4.8~5.3）
慢乙肝组	93.2（90.1~96.4）^*	14.5（13.2~16.4）^*	5.6（5.1~6.4）^*
慢乙肝后肝硬化组	96.6（92.9~102.7）^*#	15.9（14.9~17.2）^*#	7.1（5.9~8.2）^*#
慢乙肝后肝细胞癌组	93.9（89.3~98.1）^*△	15.0（13.5~16.2）^*△	9.4（6.7~21.4）^*#△

组别	MCV/fL	RDW/%	SAA/（mg/L）
正常对照组	91.2（89.2~93.0）	13.0（12.7~13.3）	4.9（4.8~5.3）
慢乙肝组	93.2（90.1~96.4）^*	14.5（13.2~16.4）^*	5.6（5.1~6.4）^*
慢乙肝后肝硬化组	96.6（92.9~102.7）^*#	15.9（14.9~17.2）^*#	7.1（5.9~8.2）^*#
慢乙肝后肝细胞癌组	93.9（89.3~98.1）^*△	15.0（13.5~16.2）^*△	9.4（6.7~21.4）^*#△

项目	曲线下面积	最佳临界值	敏感性/%	特异性/%	95%可信区间
MCV	0.71	95.35	60.71	80.68	0.61 ~0.81
RDW	0.83	14.25	87.50	69.32	0.76 ~0.89
SAA	0.78	5.85	78.57	71.59	0.69~ 0.86
MCV+RDW+SAA	0.87		92.86	72.73	0.82~ 0.93

项目	曲线下面积	最佳临界值	敏感性/%	特异性/%	95%可信区间
MCV	0.71	95.35	60.71	80.68	0.61 ~0.81
RDW	0.83	14.25	87.50	69.32	0.76 ~0.89
SAA	0.78	5.85	78.57	71.59	0.69~ 0.86
MCV+RDW+SAA	0.87		92.86	72.73	0.82~ 0.93

项目	曲线下面积	最佳临界值	敏感性/%	特异性/%	95%可信区间
MCV	0.49	95.75	40.22	67.36	0.42~0.57
RDW	0.54	14.85	58.70	58.33	0.47~0.62
SAA	0.78	9.28	53.26	92.36	0.72~0.85