非侵入性肝纤维化诊断模型对慢性乙肝病毒感染者肝纤维化的诊断价值  

Assessment of noninvasive diagnostic models for predicting liver fibrosis in patients with chronic hepatitis B virus infection

作　　者：尹胜杰[1] 霍娜[1] 徐京杭[1] 郑金鑫[1] 王晋生[2] 孙谢文[2] 陈新月[3] 斯崇文[1] 于岩岩[1] 

机构地区：[1]北京大学第一医院感染疾病科,100034 [2]秦皇岛市第三医院肝病科 [3]首都医科大学附属北京佑安医院

出　　处：《北京医学》2010年第6期417-420,共4页Beijing Medical Journal

基　　金：北京市病毒性肝炎诊断及治疗的关键技术研究(D08050700650802);国家"十一五"重大专项:慢性乙型肝炎临床治疗方案的优化及影响因素的研究(2008ZX10002-004)

摘　　要：目的探讨6种非侵入性模型(APRI、Hepascore、Fibroindex、SLFG、S指数和Hui模型)对慢性乙肝病毒(HBV)感染者肝纤维化的诊断价值。方法对128例慢性HBV感染者行肝活检及血清学指标检测,根据Scheuer分期标准,将肝纤维化分期设定两个判定点,显著纤维化(S2～S4期)和广泛纤维化(S3～S4期)。以肝活检病理结果为金标准,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评价6种诊断模型对慢性乙型肝炎患者显著纤维化及广泛纤维化的诊断价值。结果各非侵入性诊断模型区别显著纤维化(S0S1与S2S3S4)的AUROC范围为Fi-broindex0.852(95%CI:0.703～0.890,P﹤0.01)至Hepascore0.671(95%CI:0.572～0.769,P﹤0.01);区别严重纤维化(S0S1S2与S3S4)的AUROC范围为Fibroindex0.780(95%CI:0.698～0.863,P﹤0.01)至Hepascore0.682(95%CI:0.589～0.776,P﹤0.01);诊断准确率集中于60%～80%。结论运用无创性诊断模型评价慢性乙型肝炎肝纤维化严重程度具有敏感、准确和可重复性,可监测和评估慢性乙型肝炎肝纤维化的动态变化。Objective To testify the diagnostic values of six noninvasive diagnostic models （APRI,Hepascore,Fibroindex,SLFG,S index,Hui model）for predicting liver fibrosis in patients with chronic hepatitis B virus infection.Methods According to the Scheuer scoring system,liver fibrosis stages were assessed in 128 patients with chronic HBV infection who underwent liver biopsies and serum tested.Two different endpoints were studied according to liver fibrosis stage,namely significant fibrosis （S2 to S4）,extensive fibrosis （S3 to 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.Results Overall diagnostic performance of scores determined by AUROCs ranged from 0.852 （95% CI：0.703～0.890,P ﹤0.01）for Fibroindex to 0.671 （95% CI：0.572 ～0.769,P ﹤ 0.01）for Hepascore for discriminating S0S1 versus S2S3S4 ;AUROCs ranged from 0.780 （95%CI：0.698～0.863,P ﹤0.01）for Fibroindex to 0.682 （95% CI：0.589～0.776,P ﹤0.01）for Hepascore for discriminating S0S1S2 versus S3S4.These models could identify accurately 60% to 80% of patients.Conclusions Current noninvasive diagnostic models for predicting liver fibrosis in patients with chronic hepatitis B virus infection appear to be sensitive,accurate and reproducible,suggesting they could be used to assist or replace liver biopsy to detect dynamic changes of HBV-related liver fibrosis.

关 键 词：肝纤维化 肝活检 慢性乙型肝炎 非侵入性诊断 

分 类 号：R575.2[医药卫生—消化系统]