CAJ | 학술논문

目的：探讨早期诊断慢性乙型肝炎（慢性乙肝）引起的慢加急性肝衰竭的相关指标。方法收集由慢性乙肝引起的慢加急性肝衰竭病例共13例，随机配对39例慢性乙肝病例，分析两组相关指标的差异。将有差异的指标行ROC曲线分析，再将ROC曲线下面积（AUC）＞0．8的指标入选为积分指标，根据约登指数确定cutoff值。各病例中积分指标≥cutoff值的记1分，＜cutoff值的记0分，总积分再行ROC曲线分析，根据约登指数确定总积分的 cutoff值，计算敏感度、特异性。结果 AUC ＞0．8的指标有丙氨酸氨基转移酶（ALT）／正常范围最大值（ULN）、中性粒细胞计数（N）、碱性磷酸酶（AKP）／ULN、天冬氨酸氨基转移酶（AST）／ULN、直接胆红素／总胆红素（Dbil／Tbil）、总胆汁酸（TBA），AUC 分别为0．869、0．874、0．897、0．917、0.919、0．978，cutoff值分别为18．57、3．1×109／L、0．99、22．21、44．41％、140．20μmol／L。六个指标的总积分cutoff值为4分，AUC 为0．987，约登指数0．949，早期诊断慢性乙肝引起的慢加急性肝衰竭的敏感度100.00％，特异性94．87％。结论根据ALT／ULN、N、AKP／ULN、AST／ULN、Dbil／Tbil、TBA这六个指标的积分可以早期诊断慢性乙肝引起的慢加急性肝衰竭。
목적：탐토조기진단만성을형간염（만성을간）인기적만가급성간쇠갈적상관지표。방법수집유만성을간인기적만가급성간쇠갈병례공13례，수궤배대39례만성을간병례，분석량조상관지표적차이。장유차이적지표행ROC곡선분석，재장ROC곡선하면적（AUC）＞0．8적지표입선위적분지표，근거약등지수학정cutoff치。각병례중적분지표≥cutoff치적기1분，＜cutoff치적기0분，총적분재행ROC곡선분석，근거약등지수학정총적분적 cutoff치，계산민감도、특이성。결과 AUC ＞0．8적지표유병안산안기전이매（ALT）／정상범위최대치（ULN）、중성립세포계수（N）、감성린산매（AKP）／ULN、천동안산안기전이매（AST）／ULN、직접담홍소／총담홍소（Dbil／Tbil）、총담즙산（TBA），AUC 분별위0．869、0．874、0．897、0．917、0.919、0．978，cutoff치분별위18．57、3．1×109／L、0．99、22．21、44．41％、140．20μmol／L。륙개지표적총적분cutoff치위4분，AUC 위0．987，약등지수0．949，조기진단만성을간인기적만가급성간쇠갈적민감도100.00％，특이성94．87％。결론근거ALT／ULN、N、AKP／ULN、AST／ULN、Dbil／Tbil、TBA저륙개지표적적분가이조기진단만성을간인기적만가급성간쇠갈。
Objective To investigate the related index of early diagnosis of acute-on-chronic liver failure caused by chronic hepatitis B.Methods 13 cases of the acute-on-chronic liver failure caused by chronic hepatitis B were collected in our department,39 cases of chronic hepatitis B were randomly paired to analyze the difference index.ROC curve analysis was conducted for the different data,then to choose the data whose AUC (area under the curve)is >0.8 to accumulate points,while the cutoff value in the light of Youden index was indentified.Each accu-mulating points data would score 1 point if it is≥cutoff value,otherwise,it would score 0 points.ROC curve analysis was conducted for the total accumulating points,the cutoff value of the total accumulating points according to Youden index was indentified,the sensitivity and specificity were calculated.Results The data of which AUC are >0.8 include glutamic-pyruvic transaminase (ALT)/Upper Limit Of Normal (ULN),neutrophil count (N),alkaline phosphatase (AKP)/ULN,glutamic-oxalacetic transaminease(AST)/ULN,direct bilirubin/total bilirubin(Dbil/Tbil),total bile acid(TBA),whose AUC were respectively 0.869,0.874,0.897,0.917,0.919 and 0.978,while their cutoff value were respectively 18.57,3.1 ×109/L,0.99,22.21,44.41%and 140.20μmol/L.The cutoff value of total accumula-ting points of the six data was 4 points,AUC was 0.987,Youden index was 0.949,and their sensitivity for ealier diag-nosis for the acute -on -chronic liver failure caused by chronic hepatitis B was 100%,specificity was 94.87%. Conclusion The accumulating points of the six data aboved (ALT/ULN,N,AKP/ULN,AST/ULN,Dbil/Tbil,TBA) will help the early diagnosis of acute-on-chronic liver failure caused by chronic hepatitis B.