天冬氨酸氨基转移酶/血小板指数预测慢性乙型肝炎患者肝组织病理状态的价值  

The aspartate aminotransferase to platelet ratio index for prediction of pathological status of liver in patients with chronic hepatitis B

作　　者：张占卿[1] 陆伟[1] 杨丽芳[1] 史连国[1] 

机构地区：[1]复旦大学附属公共卫生临床中心,上海市201508

出　　处：《实用肝脏病杂志》2008年第6期366-369,共4页Journal of Practical Hepatology

摘　　要：目的探讨天冬氨酸氨基转移酶/血小板指数(APRI)预测慢性乙型肝炎患者肝组织病理状态的价值。方法对慢性乙型肝炎171例患者进行肝穿刺行病理学分级和分期检查。检测患者血清天冬氨酸氨基转移酶(AST)和血小板(BPC)计数。采用单因素方差分析评价受试者工作特征(ROC)曲线下面积。结果AST和APRI在G1与G2之间有显著性差异(P=0.001和0.002),在G2与G3、G3与G4之间均无显著性差异(P=0.926和0.551、0.926和0.805);BPC在G1与G2、G2与G3、G3与G4之间均无显著性差异(P=0.464、0.388、0.218)。AST和APRI在S0与S1、S1与S2、S2与S3、S3与S4之间均无显著性差异(P=0.203和0.747、0.378和0.265、0.714和0.256、0.916和1.000);BPC在S2与S3之间有显著性差异(P=0.008),在S0与S1、S1与S2、S3与S4之间均无显著性差异(P=0.670、0.815、0.180)。AST和APRI预测G2～4的ROC曲线下面积分别为0.76和0.71(95%CI分别为0.67～0.86和0.61～0.80),最佳截断值分别为74.0U/L和0.84;当AST≥74.0U/L和APRI≥0.84时,其预测G2～4的灵敏度、特异度、阳性预测值、阴性预测值、准确度、Youden指数分别为61%和54%、83%和83%、95%和94%、37%和27%、65%和59%、44%和36%。BPC预测S3～4的ROC曲线下面积为0.31(95%CI为0.23～0.39),最佳截断值为141.50×109/L;当BPC≤141.50×109/L时,其预测S3～4的灵敏度、特异度、阳性预测值、阴性预测值、准确度、Youden指数分别为82%、55%、66%、74%、69%、37%。结论APRI对乙型肝炎相关性显著的炎症活动(G2～4)有一定的预测价值,但不优于AST;APRI对乙型肝炎相关性显著的肝纤维化(S2～4)或严重肝纤维化(S3～4)或肝硬化(S4)无预测价值,而BPC对乙型肝炎相关性严重的肝纤维化(S3～4)有预测价值。Objective To explore the aspartate aminotransferase to platelet ratio index （APRI） for prediction of pathological status of liver in patients with chronic hepatitis B. Methods 171 consecutive patients with chronic hepatitis B were retrospectively studied. The pathological grading and staging of the liver biopsy specimens were assessed. One-way ANOVA was used for comparisons of serum aspartate aminotransferase（AST） levels,blood platelet eounts（BPC）,APRI among different pathological grading （G0 to G4） and staging （S0 to S4）. Receiver operating characteristic （ROC） curve was used to predict the different pathological grading and staging. Results There were significant differences in AST and APRI between G1 and G2 （P=0.001 and 0.002）;and no significant differences between G2 and G3,G3 and G4 （P=0.926 and 0.551,0.926 and 0.805）. There were no significant differences in BPC between G1 and G2,G2 and G3,G3 and G4 （P=0.464,0.388,0.218）. There were no significant differences in AST and APRI between SO and S1,S1 and S2,S2 and S3,S3 and S4 （P=0.203 and 0.747,0.378 and 0.265,0.714 and 0.256,0.916 and 1.000）. There was a significant difference in BPC between S2 and S3 （P=0.008）;and no significant differences between SO and S1,S1 and S2,$3 and S4 （P=0.670,0.815,0.180）. The area under ROC curve of AST and APRI for prediction of G2 to 4 from G1 were 0.76 （95%CI：0.67-0.86） and 0.71 （95%CI：0.61-0.80）,respeetively;and the optimal cut-off value of which were 74.0U/L 和 0.84,respectively. Taking AST≥74.0U/L and APRI≥0.84 for prediction of G2 to 4 from G1,the sensitivity,specificity, positive predictive value,negative predictive value,accuracy,Youden index were 61% and 54%,83% and 83%,95% and 94%,37% and 27%,65% and 59%,44% and 36%, respectively. The area under ROC curve of BPC for prediction of S3 to 4 from SO to 2 was 0.31 （95%CI：0.23-0.39）,and the optimal cut-off value of which was 141.50×10^9/L. Taking BPC≤〈141.50×10^9/L for prediction of S3 to 4 from SO t

关 键 词：慢性乙型肝炎 无创模型 天冬氨酸氨基转移酶 血小板计数 病理分级 病理分期 

分 类 号：R512.6[医药卫生—内科学]