谷氨酰转肽酶/HBsAg比值评估慢性乙型肝炎患者肝纤维化的价值探讨  

Judgement of liver fibrosis by gama-glutamyltransferase to q HBs Ag ratio in patients with chronic hepatitis B

作　　者：李旭[1] 张振华[1] 蔡群[1] 谢琴秀[1] 张亚飞[1] 江晓平[1] 李旭[1] 尹华发 

机构地区：[1]安徽医科大学第一附属医院感染病科,合肥市230022

出　　处：《实用肝脏病杂志》2015年第2期141-144,共4页Journal of Practical Hepatology

基　　金：国家自然科学基金资助项目(编号:81273142);教育部博士点基金资助项目(编号:20093420120005)

摘　　要：目的评价血清γ-谷氨酰转肽酶(γ-GT)与HBs Ag定量比值(Gq HBs R)判断慢性乙型肝炎患者肝纤维化程度的价值。方法在232例进行肝穿刺的慢性乙型肝炎患者,采用美国罗氏公司提供的化学发光法试剂检测HBs Ag定量;将≥S2作为显著纤维化组,<S2组作为轻度或无纤维化组,采用受试者工作特征曲线(ROC)评价该比值在不同截点时对于显著性肝纤维化的诊断价值。结果 Gq HBs R判断有无显著性肝纤维化时的ROC曲线下面积(AUC)为0.704。当Gq HBs R>9.57时,诊断显著肝纤维化的敏感性为49.2%、特异性为88.2%、阳性预测值(PPV)为84.2%、阴性预测值(NPV)为57.7%;当Gq HBs R>10时,其特异性和PPV分别为88.2%和83.3%;当Gq HBs R>20时,其特异性和PPV均为100%;当Gq HBs R<2.4时,其敏感性和阴性预测值分别为98.4%和81.8%;当Gq HBs R<2时,其敏感性和阴性预测值均为100%。随着Gq HBs R逐渐增大,其特异性和PPV逐渐增大,随着Gq HBs R逐渐变小,其敏感性和NPV逐渐增大。在特异性和PPV分别为88.2%和83.3%,敏感性和NPV分别为98.4%和81.8%时,可避免约40%患者进行肝穿刺。基于4因素的肝纤维化指数(FIB-4)、天冬氨酸氨基转移酶与血小板比值(APRI)、γ-GT、HBs Ag单独判断有无显著性肝纤维化的AUC分别为0.638、0.631、0.606、0.588,而Gq HBs R判断有无显著性肝纤维化的AUC明显优于FIB-4、APRI、γ-GT或HBs Ag。结论非创伤性诊断模型Gq HBs R能较好地区分存在显著性肝纤维化,对于慢性乙型肝炎患者的抗病毒治疗或许有一定的指导意义。Objective To assess the liver fibrosis by serum gama-glutamyltransferase （γ-GT） and HBsAg quantification （qHBsAg） ratio （GqHBsR） in patients with chronic hepatitis B. Methods A total of 232 patients with chronic hepatitis B were enrolled and all had liver biopsied. Serum γ-GT and HBsAg were detected. Liver fibrosis was believed to be significant as ≥S2 and to be mild or without fibrosis as less than S2 existed. Diagnos-tic efficacy of GqHBsR was assessed at different cut-off values for significant liver fibrosis by using receiver op-erating characteristic （ROC） curves. Results The area under ROC （AUC） of GqHBsR for significant liver fibro-sis was 0.704. When the GqHBsR was greater than 9.570 for significant liver fibrosis,the sensitivity,specificity, positive predictive value （PPV） and negative predictive value （NPV） were 49.2%,88.2%,84.2% and 57.7%;When the GqHBsR was 〉10 for significant liver fibrosis,the specificity and PPV were 88.2% and 83.3%,respectively;When the GqHBsR was〉20 for significant liver fibrosis,specificity and PPV were both 100%;When the GqHBsR was 〈2.4 for significant liver fibrosis,the sensitive and NPV were 98.4% and 81.8%,respectively;When the GqHB-sR was 〈2 for significant liver fibrosis,the sensitive and NPV were both 100%;The area under ROC （AUC） of fi-brosis index based on the 4 factor（FIB-4）,aspartate aminotransferase to platelet ratioindex（APRI）,γ-GT and HB-sAg for significant liver fibrosis were 0.638,0.631,0.606 and 0.588,respectively,all were less efficient as compared to that of GqHBsR. Conclusion GqHBsR yields a higher AUC than aspartate aminotransferase to platelet ratio index,FIB-4,γ-GT or HBsAg. This noninvasive diagnostic models for determination of liver fibrosis might be use-ful in clinical practice.

关 键 词：慢性乙型肝炎 HBS Ag Γ-谷氨酰转肽酶 肝纤维化 

分 类 号：R512.62[医药卫生—内科学]