临床诊断的慢性乙型肝炎病毒携带者肝纤维化程度的非创伤性评价  

Non-invasive method for assessment of liver fibrosis in clinically diagnosed chronic hepatitis B virus carriers

作　　者：王伟[1] 杨方[1] 魏倪 杨晴[1] 刘丹阳[1] 赵兵[1] 

机构地区：[1]沈阳市第六人民医院二病房,110006

出　　处：《中华传染病杂志》2012年第1期29-32,共4页Chinese Journal of Infectious Diseases

摘　　要：目的评价常规实验室检测指标在判断慢性HBV携带者肝纤维化程度中的作用。方法选择196例临床诊断的慢性HBV携带者行肝组织活检及常规实验室检查。观察血常规、AST／ALT、AST与PLT比值指数（APRI），年龄-PLT指数（API）；以SO（112例）及S1～S3（84例）分组比较，计量资料采用Wilcoxon秩和检验，计数资料采用x2检验。结果196例慢性HBV携带者HBVDNA均阳性，HBeAg阳性156例，占79．6％；S1～S3组与SO组比较，年龄偏大、ALT、AST、AST／ALT、APRI及API增高，而PLT和HBVDNA下降（统计值=7．705、6．33、7．095、4．977、11．059、8．936、10．196，均P〈0．05）；APRI和API的曲线下面积〉0．70，分别为0．827和0．829。API灵敏度最高为70．46％，其阴性预测值为71．43％}APRI特异度最高为92．94％，阳性预测值为92．86％；以APRI≥0．30作为有肝纤维化的诊断，119例中包括了97．62％肝纤维化患者；以API≥4．0作为有肝纤维化的诊断，112例中包括了96．43％肝纤维化患者。结论常规实验室检测可用于慢性HBV携带者的肝纤维化程度判断，APRI和API是具有简便、易得且较有价值的临床指标。Objective To verify the value of routine laboratory markers for assessment of liver fibrosis status in chronic hepatitis B virus （HBV） carriers. Methods A total of 196 patients who were clinically diagnosed with chronic HBV carriers with liver biopsy and routine laboratory test were included in this study. The data of complete blood count, aspartate aminofransferase/alanine aminotransferase （AST/ALT）, aspartate aminotransferase to platelet ratio index （APRI） and ageplatelet index （API） were collected and calculated. Patients were divided into group S0 （n= 112） and group S1-S3 （n= 84） based on liver fibrosis stages. Measurement data were analyzed by Wilcoxon rank sum test and enumeration data were analyzed by chi square test. Results All 196 enrolled HBV carriers were HBV DNA positive, with 156 （79.6%） HBeAg-positive. Age, ALT, AST, AST/ ALT, APRI and API were all significantly higher in group S1- S3 than those in group SO （statistic value：7.705,6.33,7.095,4.977,11.059,8.936, respectively; all P〈0.05）. However, PLTlevel was lower in the former group compared to that in the latter group （statistic value： 10. 196, P〈0.05）. The area under receiver operating characteristic curve （AUROC） of APRI and API were 0. 827 and 0. 829, respectively. The highest sensitivity and negative prediction value （NPV） were 70.46% and 71.43% respectively when using API. The best specificity and positive prediction value （PPV） was 92.94% and 92.86%, respectively when using APRI. When APRI≥0.30 was used as the cut-off of liver fibrosis, 97.62% of 119 patients were diagnosed with liver fibrosis; when API≥4.0 was used as the cut-off of liver fibrosis, 96. 43% of 112 patients were diagnosed with liver fibrosis. Conclusion APRI and API are two simple and feasible non-invasive biochemical markers that can be used to determine liver fibrosis status in chronic HBV carriers.

关 键 词：肝硬化 ROC曲线 带病原状态 肝炎 乙型 慢性 

分 类 号：R575[医药卫生—消化系统] R51[医药卫生—内科学]