检验医学中常见的比值及其意义

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                    <p style=""><strong style=""><strong style="max-width: 100%; color: rgb(68, 68, 68); font-family: 宋体; line-height: 28px; text-align: justify; white-space: normal; word-wrap: break-word !important; box-sizing: border-box !important;"><img src="http://mmbiz.qpic.cn/mmbiz/cNuNdEZ2BK7eIOv9Picyop7PMgk4WxqGic2j5DxUL3wUSibm7NHtElM54LKicnibUXq4tOGwibRI4usKjpCZN6JKgQkQ/0" data-ratio="0.11857707509881422" data-w="" width="auto" src="http://mmbiz.qpic.cn/mmbiz/cNuNdEZ2BK7eIOv9Picyop7PMgk4WxqGic2j5DxUL3wUSibm7NHtElM54LKicnibUXq4tOGwibRI4usKjpCZN6JKgQkQ/0" style="word-wrap: break-word !important; box-sizing: border-box !important; width: auto !important; visibility: visible !important;"  /></strong></strong>由于大型设备的使用，现在的检验报告单，从过去单一的几项变成了现在的几十项。报告单除项目报告外，通常还会出现一些特别的比值项目报告，较常规的如清蛋白/球蛋白(A/G)比值，但现在会在报告单中出现较多的比值，如天门冬酸氨基转移酶/丙氨酸氨基转移酶(AST/ALT)、直接胆红索/总胆红素(DBil/TBil)等。这些比值能为临床提供有用的协助诊断和鉴别诊断。</p><p style="">　　<strong style="max-width: 100%; word-wrap: break-word !important; box-sizing: border-box !important;">1、AST/ALT </strong></p><p style="">　　临床上常用AST/ALT的比值来反映肝细胞的损害情况。ALT位于肝细胞浆内，而AST位于肝细胞浆和线粒体内，正常人AST/ALT比值为1.15左右，也就是AST较ALT稍高。当肝细胞轻度病变时，仅有肝细胞浆内的酶释出，ALT上升幅度较AST为大。象急性肝炎早期，AST/ALT比值可降到0.56左右，肝炎恢复期，比值逐渐上升至正常。当肝细胞严重损害时，胞浆、线粒体中的酶释放入血，以致血清AST升高幅度较ALT为大。如肝硬化时，比值可增高至1.44,慢性活动性肝炎比值也常高于正常。总之，肝病时AST/ALT比值&lt;1,常提示肝脏损害较轻，AST/ALT比值&gt;1,则提高肝脏损害较重。但是酒精对线粒体有特殊损害，90%以上的急性酒精性肝炎病例，AST/ALT比值&gt;1,为一例外。</p><p style="">　　<strong style="max-width: 100%; word-wrap: break-word !important; box-sizing: border-box !important;">2、DBIL/TBIL</strong></p><p style="">　　DBIL/TBIL&lt;20%提示为溶血性黄疸， DBIL/TBIL&gt;20%-50%提示为肝细胞性黄疸， DBIL/TBIL&gt;50%提示胆汁淤积性黄疸。特别是在一部分TBIL正常的患者中，约有30%-50%的人DBIL/TBIL&gt;20%,提示肝炎早期，无黄疸性肝炎，失代偿肝硬化，肝癌早期。</p><p style="">　　<strong style="max-width: 100%; word-wrap: break-word !important; box-sizing: border-box !important;">3、A/G</strong></p><p style="">　　白球比例（A/G）主要是指白蛋白和球蛋白的比值，一般肝功能正常的情况下白球比例为正常值，白蛋白要高于球蛋白。由于我们人体内的白蛋白是在肝脏制造的，当肝功能出现异常时，作为白球比例中分子的白蛋白就会减少，出现白球比例偏低的现象。正常人很少出现白球比偏低，血液中的白蛋白与球蛋白比值不应&lt;1.5,如果低于这个值，常见于肝硬化、肝功能不全、肾病（蛋白尿）等会造成白蛋白偏低的疾病患者。白蛋白与球蛋白比值&lt;1时称为白球倒置，诊断肝硬化更有价值。</p><p style="">　　<strong style="max-width: 100%; word-wrap: break-word !important; box-sizing: border-box !important;">4、FPSA/TPSA</strong></p><p style="">　　目前，国内通常把TPSA&gt;4 ug/L作为筛选前列腺癌的临界值，把TPSA结果在4~10 ug/L之间称为灰色区域，前列腺癌与前列腺增生均有可能，而当TPSA&gt;10 ug/L时，前列腺癌可能性极大。FPSA则越高越好，常以FPSA/TPSA比值0.19为临界值，当血清TPSA在灰色区域时，FPSA/TPSA显得非常重要，FPSA/TPSA&gt;0.19时，前列腺癌可能性小，当FPSA/TPSA值&lt;0.19时，前列腺癌可能性较大。TPSA在正常范围，FPSA/TPSA比值则忽略不计。</p><p style="">　　<strong style="max-width: 100%; word-wrap: break-word !important; box-sizing: border-box !important;">5、PGI/PGII</strong></p><p style="">　　联合测定PGI和PGII比值可起到胃底腺粘膜“血清学活检”的作用。常见意义如下：</p><p style="">　　PGI≥70ng/ml 或PGI/PGII   阴性（-）    正常</p><p style="">　　PGI&lt;70ng/ml  并且PGI/PGII 阳性（+）    轻度萎缩</p><p style="">　　PGI&lt;50ng/ml  并且PGI/PGII  中度阳性（2+）  中度萎缩</p><p style="">　　PGI&lt;30ng/ml  并且PGI/PGI  I强阳性（3+）   高度萎缩</p><p style="">　　PG检测对胃部疾病预后动态变化分析 :</p><p style="">　　PGI&gt;240或PGII&gt;20时，胃黏膜有破损，建议做胃镜进一步检查或禁酒等两周后复查。可能原因为PGII较稳定，但因胃粘膜受攻击或受破坏时活动期的PGI会明显增加。HP感染、浅表性胃炎、糜烂性胃炎、胃溃疡、十二指肠溃疡，可致血清PGⅠ、PGⅡ增高。胃溃疡复发PGⅡ增高明显，十二指肠溃疡复发PGⅠ、PGⅡ增高明显。</p><p style="">　　PGI&lt;70,PGI/PGII&lt;3时，PGI/PGII&lt;3胃黏膜细胞萎缩，建议做胃镜进一步检查，以萎缩性胃炎居多，特别注意有萎缩性胃炎、肠化生、异型增生、胃癌等的高风险因素。</p><p style="">　　PGI&lt;70,PGI/PGII&gt;3胃蛋白酶原分泌较少，建议定期复查，以胃酸分泌少居多，有萎缩性胃炎、肠化生等的高风险。</p><p style=""><span style="max-width: 100%; color: rgb(51, 51, 51); font-family: 宋体; font-size: 14px; line-height: 24px; background-color: rgb(231, 240, 247); word-wrap: break-word !important; box-sizing: border-box !important;"><span style="max-width: 100%; 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