血浆氨基酸比例模型诊断慢性乙型肝炎肝组织病理状态的效能  

Appraisement of the ratio models of plasma amino acids for diagnosis of pathological status of liver tissues in patients with chronic hepatitis B

作　　者：陆伟[1] 张占卿[1] 贾小芳[1] 张丽军[1] 王雁冰[1] 丁荣蓉[1] 周新兰[1] 冯艳玲[1] 

机构地区：[1]上海市公共卫生临床中心,上海201508

出　　处：《现代中西医结合杂志》2014年第9期913-918,1002,共7页Modern Journal of Integrated Traditional Chinese and Western Medicine

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/重点基金资助项目(2006AA02A411)

摘　　要：目的 探讨基于6种氨基酸血浆摩尔浓度构建的比例模型诊断慢性乙型肝炎肝组织病理学状态的效能.方法 选择经肝组织病理学检查的慢性乙型肝炎患者148例,病理学分级G2、G3、G4分别被称为显著炎症、严重炎症和进展期炎症,分期S2、S3和S4分别被定义为显著纤维化、严重纤维化和进展期纤维化.血浆氨基酸摩尔浓度测定采用Agilent 1100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.选择与病理学分级和分期有显著相关性的相关系数由大到小排列的前6个模型进行分析.血浆氨基酸比例模型诊断肝组织不同炎症活动度和纤维化程度的评价采用ROC曲线法.结果 亮氨酸/酪氨酸、（亮氨酸＋缬氨酸）/酪氨酸、（异亮氨酸＋亮氨酸＋缬氨酸）/酪氨酸、亮氨酸/（酪氨酸＋蛋氨酸）、（异亮氨酸＋亮氨酸）/（酪氨酸＋蛋氨酸）、（异亮氨酸＋缬氨酸）/酪氨酸诊断显著和严重炎症的ROC曲线下面积之间无显著性差异（P均＞0.05）;其最佳截断值对应的灵敏度、特异度、准确度分别为0.37 ～0.55,0.79 ～0.97,0.51 ～0.61和0.53 ～0.67,0.69 ～0.86,0.68～0.74.（异亮氨酸＋亮氨酸）/酪氨酸、亮氨酸/酪氨酸、（异亮氨酸＋亮氨酸＋缬氨酸）/酪氨酸、（亮氨酸＋缬氨酸）/酪氨酸、（异亮氨酸＋缬氨酸）/酪氨酸、缬氨酸/酪氨酸诊断严重和进展期纤维化ROC曲线下面积之间无显著性差异（P均＞0.05）;其最佳截断值对应的灵敏度、特异度、准确度分别为0.52～0.76,0.59 ～0.83,0.66～0.69和0.53 ～0.83,0.64～0.82,0.68 ～0.76.结论 基于氨基酸血浆摩尔浓度的部分比例模型对诊断显著和严重炎症、严重和进展期纤维化均有一定意义,但其中符合成本效益原则的最佳模型尚不能明确.Objective It is to approach the efficacy of the ratio models based on plasma molar concentrations of 6 amino acids for diagnosis of pathological status of liver tissues in patients with chronic hepatitis B.Methods 148 patients with chronic hepatitis B with pathological diagnoses of liver tissue were enrolled in present study.The pathological grading G2,G3,G4 and staging S2,S3,S4 was defined as significant,severe,advanced inflammation and fibrosis,respectively.Plasma molar concentrations of amino acids were determined by Agilent 1100 series high performance liquid chromatography.The ratio models of plasma amino acids were established by fraction function.The number of the ratio models based on all possible combinations of the variables was great,so the top six ratio models were selected and analyzed according to the correlation coefficients from big to small order,in which the ratio models were correlated significantly with the pathological grading and staging.ROC curve method was used for appraisement of the ratio models of plasma amino acids for diagnosis of pathological status of liver tissues.Results There were no statistical significances （P ＞ 0.05） between the areas under ROC curves of leucine / tyrosine,（ileucine ＋ valine）/tyrosine,（ileucine ＋ leucine ＋ valine） / tyrosine,leucine / （tyrosine ＋ methionine）,（ileucine ＋ valine） /（tyrosine ＋ methionine）,（ileucine ＋ valine） / tyrosine for diagnosis of significant and severe inflammation; and the areas under ROC curves of all the six ratio models for diagnosis of significant and severe inflammation were 0.686 to 0.689 and 0.694 to 0.704 ; the sensitivity,specificity,accuracy corresponding to the optimal cutoff were 0.37 to 0.55,0.79 to 0.97,0.51 to 0.61 and 0.53 to 0.67,0.69 to 0.86,0.68 to 0.74.There were no statistical significance （P ＞ 0.05） between the areas under ROC curves of （ileucine ＋ leucine） / tyrosine,leucine / tyrosine,（ileucine ＋ leucine ＋ valine） / tyrosine,（leucine ＋valine） / ty

关 键 词：氨基酸 乙型肝炎 肝纤维化 比例模型 ROC曲线 无创诊断 

分 类 号：R512.62[医药卫生—内科学]