基于年龄与氨基酸比例构建的Logistic回归分析模型诊断乙型肝炎相关肝纤维化程度的效能评价  

Diagnosis of hepatic fibrosis in hepatitis B patients by logistic regression modeling based on plasma amino acid ratio and age

作　　者：张占卿[1] 陆伟[1] 王雁冰[1] 贾小芳[2] 张利军[2] 丁荣蓉[1] 周新兰[1] 冯艳玲[3] 

机构地区：[1]上海市公共卫生临床中心肝病二科,上海201508 [2]上海市公共卫生临床中心科研中心,上海201508 [3]上海市公共卫生临床中心病理科,上海201508

出　　处：《临床肝胆病杂志》2013年第5期330-335,共6页Journal of Clinical Hepatology

基　　金：上海市科委医学引导类项目(09411965800);国家"863"高技术研究发展计划生物和医药领域重大/重点基金(2006AA02A411)

摘　　要：目的探讨基于年龄和氨基酸比例模型构建的Logistic回归模型诊断乙型肝炎相关肝纤维化程度的效能。方法 148例经肝活组织检查的慢性乙型肝炎患者入选本研究。病理学分期≥S2、≥S3和=S4分别被定义为显著、严重和进展期肝纤维化。血浆氨基酸测定采用Agilent1100系列高效液相色谱仪,血浆氨基酸比例模型通过建立分数函数的方式构建。根据部分变量组合构建的比例模型数量较大,本文只选择与病理学分期有显著相关性的相关系数由大到小排列的前6个比例模型进行分析。基于年龄和氨基酸比例模型构建的Logistic回归模型诊断肝纤维化程度的效能评价采用受试者工作特征曲线(ROC曲线)法。结果基于年龄和氨基酸比例模型构建的诊断显著肝纤维化的Logistic回归模型不成立。基于年龄和氨基酸比例模型构建的诊断严重肝纤维化的Logistic回归模型的预测概率(PPsev)诊断严重肝纤维化的ROC曲线下面积为0.722,95%CI为0.640～0.804;基于最佳截断值的PPsev诊断严重肝纤维化的灵敏度、特异度、准确度分别为0.49、0.85、0.69。基于年龄和氨基酸比例模型构建的诊断进展期肝纤维化的Logistic回归模型的预测概率(PPadv)诊断进展期肝纤维化的ROC曲线下面积为0.792,95%CI为0.708～0.876;基于最佳截断值的PPadv诊断进展期肝纤维化的灵敏度、特异度、准确度分别为0.73、0.76、0.75。结论基于年龄和氨基酸比例模型构建的Lo-gistic回归模型对乙型肝炎相关的严重和进展期肝纤维化有一定诊断价值。Objective To explore the efficacy of logistic regression modeling based on plasma amino acid profile and patient age,for diagnosing hepatic fibrosis in patients with chronic hepatitis B（CHB）.Methods One-hundred-and-forty-eight patients（108 males;mean age： 38.1±11.9 years,range： 16-72 years） histologically diagnosed with CHB at our institute between January 2009 and June 2011 were enrolled for study.Pathological staging of fibrosis classified patients as： significant（≥S2）,severe（≥S3）,or advanced（S4） stages.Plasma molar concentrations of amino acids were determined by high-performance liquid chromatography,and used to establish the top six fractional ratio models according to progressive significance of correlations with pathological stages（by Spearman′s rank correlation coefficient analysis）.The abilities of scale models to predict fibrosis were evaluated using the area under the receiver operating characteristic（AUROC） curve.ROC curve analysis allowed for the best cutoff for age to be determined for the pathological stages and calculation of sensitivity,specificity,and accuracy for the corresponding prediction probabilities（PP）.Results Patient age was postively correlated with pathological stage（rs=0.262,P=0.001）.The significant correlation coefficients for the six models were（in descending order）：（isoleucine＋leucine）/tyrosine（rs=-0.350,P=0.000）,leucine/tyrosine（rs=-0.349,P=0.000）,（isoleucine＋leucine＋valine）/tyrosine （rs=-0.345,P=0.000）,（leucine＋valine）/tyrosine（rs=-0.342,P=0.000）,（isoleucine＋valine）/tyrosine（rs=-0.336,P=0.000）,valine/tyrosine （rs=-0.311,P=0.000）. The logistic regression model based on age and the ratio models of plasma amino acids could not be established.For severe fibrosis,the PP was 0.722（95% CI： 0.640-0.804）,with sensitivity of 0.49,specificity of 0.85,and accuracy of 0.69.For advanced fibrosis,the PP was 0.792（95% CI： 0.708-0.876）,with sensitivity of 0.73,specificity of 0.76,

关 键 词：氨基酸类 肝炎 乙型 肝硬化 LOGISTIC模型 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]