综合预测模型FibroTest对慢性乙型肝炎肝纤维化的诊断价值  

Validation of FibroTest to diagnose liver fibrosis in patients with chronic hepatitis B

作　　者：赵连荣[1] 许德军[2] 陆忠华[3] 赵鸿[1] 窦晓光[4] 郎振为[5] 王贵强[1] 

机构地区：[1]北京大学第一医院感染疾病科 [2]安阳市第五人民医院,河南安阳445000 [3]无锡市传染病医院,江苏无锡214007 [4]中国医科大学盛京医院,辽宁沈阳110004 [5]北京地坛医院,北京100011

出　　处：《中国实用内科杂志》2007年第16期1274-1277,共4页Chinese Journal of Practical Internal Medicine

基　　金：卫生部临床学科重点项目(20010911)

摘　　要：目的探讨综合预测模型FibroTest对慢性乙型肝炎肝纤维化的诊断价值。方法留取2002年8月至2005年12月北京大学第一医院、安阳市第五人民医院和无锡市传染病医院的123例行肝活检的慢性乙型肝炎患者的血清,检测α2-巨球蛋白、结合珠蛋白、载脂蛋白-AⅠ、记录总胆红素和谷氨酰转肽酶的数值,并根据其结果结合患者的年龄和性别计算出FibroTest的数值。根据肝纤维化分期设定3个判定点,分别为显著纤维化（S2～S4期）,严重纤维化（S3～S4期）和肝硬化（S4期）。以肝活检病理结果为金标准绘制出FibroTest的受试者工作特征曲线,计算曲线下面积（AUC）,并与用天冬氨酸转氨酶-血小板比值指数（APRI）计算出的AUC进行比较,评价其对慢性乙型肝炎肝硬化的诊断价值。结果123例肝活检患者中S0期25例（20.3%）;S1期27例（22.0%）;S2期31例（25.2%）;S3期29例（23.6%）;S4期11例（8.9%）,即显著纤维化者（S2～S4期）71例（57.7%）,严重纤维化者（S3～S4期）40例（32.5%）,肝硬化者（S4期）11例（8.9%）。FibroTest对3个判定点的AUC值分别为0.814（95%CI：0.740～0.888,P〈0.01）,0.824（95%CI：0.749～0.898,P〈0.01）,0.723（95%CI：0.575～0.870,P=0.015）。而APRI对3种不同程度肝纤维化的AUC值分别为0.715（95%CI：0.625～0.805,P=0.001）,0.725（95%CI：0.631～0.818,P=0.002）和0.646（95%CI：0.497～0.795,P〉0.05）。结论Fi-broTest可以准确地估计慢性乙型肝炎患者有无显著纤维化,可使45.5%的患者避免进行肝脏活检,并保证87.5%的诊断准确率。Objective To testify the diagnostic value of FibroTest in patients with CHB by comparing their results with histological features. Methods During Aug 2002 to Dec 2005 cases of chronic hepatitis B were colllected from Peking University First Hospital, No. 5 People＇s Hospital of Anyang, Henan and Wuxi Hospital of Infectious Disease. All of them underwent liver biopsy with a blood sample taken simultaneously. The serum level of α2 -macroglobulin, haptoglobin, apolipoprotein A Ⅰ ,total bilirubin and gamma-glutamyl transpeptidase were tested. These results together with age and sex of the patients were put into the algorithm and final results of FibroTest were computed. Three different endpoints were studied according to liver fibrosis stage, namely significant fibrosis （ S2 to S4） , extensive fibrosis （ S3 to S4 ） and cirrhosis （ S4 ）. With liver biopsy as the gold standard, ROC curves were delineated for different endpoints. The area under the ROC curves reflected its diagnostic values. The diagnostic value of FibroTest was compared with AST to platelet ratio index（APRI）. Results One hundred and twenty-three patients were included. The distribution of their fibrosis stage was as follows, S0 ：25 （20.3%）; S1：27 （22.0%）;S2：31 （25.2%）;S3：29 （23.6%） ; S4 ： 11 （ 8.9% ）. That means seventy-one patients （57.7%） had signifieant fibrosis （ S2 to S4 ）, forty （ 32. 5% ） had extensive fibrosis （S3 to S4）and eleven （8.9%）had eirrhosis（S4）. The AUCs of FibroTest for signifieant fibrosis, extensive fibrosis and eirrhosis were 0. 814（95 % C1：0. 740 ～ 0. 888, P 〈 0. 01 ） ,0. 824 （ 95 % CI ： 0. 749 ～ 0. 898, P 〈 0.01 ）, 0. 723 （95% CI： 0. 575 ～ 0. 870, P = 0. 015 ） respeetively. Compara-tively,the AUCs of APRI were 0. 715 （95% C1：0. 625 - 0. 805 ,P = 0. 001 ） ,0. 725 （95% C1：0. 631 - 0. 818 ,P = 0. 002 ） and 0. 646（95% C1：0. 497 ～ 0. 795, P 〉 0. 05 ）, respectively. Conclusion FibroTest identifies CHB patients wi

关 键 词：肝纤维化 肝活检 慢性乙型肝炎 FibroTest 

分 类 号：R5[医药卫生—内科学]