超声波积分联合血液指标筛选和预测代偿性乙型肝炎肝硬化  

Ultrasonic scores combined with blood indexes for screening and predicting compensated liver cirrhosis in chronic hepatitis B patients

作　　者：陈永鹏[1] 侯金林[1] 戴琳[1] 王景玲[1] 朱幼芙[1] 

机构地区：[1]南方医科大学南方医院感染内科,广东广州510515

出　　处：《南方医科大学学报》2008年第12期2157-2160,共4页Journal of Southern Medical University

基　　金：广东省社会发展领域科技计划项目(63004)

摘　　要：目的探讨慢性乙型肝炎(乙肝)病人超声波积分及常见血液指标与肝组织纤维化分期相关性,以遴选乙肝肝硬化无创性诊断指标并建立诊断模型。方法回顾性分析428例肝活检慢性乙型肝炎病人资料,记录病人血液常规、血清生化指标、甲胎蛋白及HBeAg状态、超声波检查,并进行统计学分析,建立诊断模型。结果偏相关分析提示血小板、血清白蛋白、总胆红素、天冬氨酸转氨酶(AST)、AST/ALT比值、凝血酶原时间及超声波积分均与肝纤维化分期有相关性,在肝硬化与非肝硬化病人中有显著性差异;回归分析表明超声波积分、血小板、总胆红素、白蛋白及AST影响代偿性肝硬化诊断,模型ROC曲线下面积达到0.907,肝硬化指数(CI)-0.94诊断准确率84.3%、灵敏度81.7%、特异度85.0%;56.2%病人CI<-2.0,阴性预告值97.0%,漏诊3.0%;18.2%病人CI>0.15,阳性预告值77.3%,阳性似然比11.77,轻度肝纤维化仅2.7%,接近75%病人可免于肝活检。结论慢性乙肝常见检查指标中超声波积分、血小板、胆红素、白蛋白及AST联合诊断模型可有效筛选、预测代偿性肝硬化病人,显著减少肝活检病人数量。Objective To explore the correlation between ultrasonic scores, routine blood tests and stages of hepatic fibrosis in patients with chronic hepatitis B （CHB）, and identify non-invasive indexes to establish a diagnostic model for liver cirrhosis. Methods A retrospective analysis of 428 patients with CHB undergoing liver biopsies was conducted. The patients＇ hematology, serum biochemical indexes, serum alpha fetal proteins （AFP）, serum HBeAg status and ultrasonic scores were statistically analyzed. A diagnostic model was established by stepwise discriminant analysis, and aspartate aminotransferase （AST） to platelet ratio index （APRI） was used to estimate the diagnostic value. Results Partial correlation analysis indicated that platelet, serum albumin, bilirubin, AST, ratio of AST to alanine aminotmnsferase, prothrombin time and ultrasonic scores were correlated to the stages of liver fibrosis, and significantly differed between patients with and without liver cirrhosis. Logistic regression analysis identified ultrasonic scores, platelet, serum bilirubin, albumin and AST as indexes affecting the diagnosis of compensated cirrhosis. The area under receiver operation curve of model was 0.907. The cirrhosis index （CI） of -0.94 for this model was suitable for screening, with specificity of 85.0%, sensitivity of 81.7%, and accuracy of 84.3%. About 56.2% of the patients＇ CI was lower than -2.0 with the negative predictive value of 97.0% and the rate of missed diagnosis of 3.0%. About 18.2% of the patients＇ cirrhosis probabilities were above 0.15, with positive predictive value of 77.3%, and only 2.7% of the patients had mild fibrosis （F2）, suggesting that nearly 75% of the patients did not have to receive liver biopsies. Conclusion This diagnostic model integrates the ultrasonic scores, platelet, serum bilirubin, albumin and AST to enable effective screening and prediction of compensated cirrhosis, and can reduce the number of patients required to undergo liver biopsy by about 75%.

关 键 词：肝炎 乙型 慢性 血液检查 超声波检查 肝硬化 诊断 回归分析 

分 类 号：R512.62[医药卫生—内科学]