年龄和血清HBsAg、HBV DNA预测慢性乙型肝炎肝组织病理状态的研究  

Logistic regression model for prediction of liver tissue pathological status in patients with hepatitis B

作　　者：张占卿[1] 陆伟[1] 王雁冰[1] 周新兰[1] 沈芳[2] 冯艳玲[3] 

机构地区：[1]上海市公共卫生临床中心肝炎二科,上海201508 [2]上海市公共卫生临床中心检验科,上海201508 [3]上海市公共卫生临床中心病理科,上海201508

出　　处：《同济大学学报（医学版）》2015年第1期50-57,共8页Journal of Tongji University(Medical Science)

基　　金：上海市卫计委项目(20134032)

摘　　要：目的构建基于年龄和血清HBs Ag、HBV DNA诊断慢性乙型肝炎肝组织不同病理状态的Logistic回归模型,优化血清HBs Ag、HBV DNA诊断肝组织不同病理状态的效能。方法经肝组织活检的慢性乙型肝炎患者472例,其中HBe Ag阳性279例,HBe Ag阴性193例。血清HBs Ag和HBe Ag采用Abbott Architect I2000及其配套试剂检测,血清HBV DNA采用实时荧光定量PCR检测。统计分析采用SPSS 13.0软件。结果 HBe Ag阳性患者的血清HBs Ag和HBV DNA与病理学分级和分期均呈显著负相关(P<0.05);HBe Ag阴性患者的血清HBV DNA与病理学分级和分期呈显著正相关(P<0.01)。预测HBe Ag阳性和阴性患者不同病理状态的回归模型的预测概率诊断不同病理状态的ROC曲线下面积均显著大于对角参考线下面积(P<0.01)。对HBe Ag阳性患者,预测进展期纤维化的回归模型的预测概率和血清HBs Ag诊断进展期纤维化的最佳截断值分别为≥0.185和≤3.797 log10IU/ml,其对应的灵敏度、特异度、准确度分别为0.886、0.646、0.706和0.800、0.660、0.695;对HBe Ag阴性患者,预测显著纤维化的回归模型的预测概率和血清HBV DNA诊断显著纤维化的最佳截断值分别为≥0.603和≥3.095 log10IU/m L,其对应的灵敏度、特异度、准确度分别为0.636、0.720、0.668和0.669、0.653、0.663。结论基于年龄和血清HBs Ag、HBV DNA构建的Logistic回归模型可提升血清HBs Ag、HBV DNA诊断肝组织不同病理状态的效能。Objective To construct a Logistic regression model based on age and serum HBs Ag,HBV DNA for prediction of liver tissue pathological states in patients with chronic hepatitis B.Methods Total 472 consecutive chronic hepatitis B patients with pathological diagnoses of liver tissues,including 279 HBe Ag-positive and 193 HBe Ag-negative patients,were enrolled in present study. Serum HBs Ag and HBe Ag were determined by Abbott Architect I2000 and auxiliary reagents,serum HBV DNA was determined by real-time fluorescence quantitative PCR. SPSS 13. 0 software was used for statistical analyses. Results In HBe Ag-positive patients,serum HBs Ag and HBV DNA were negatively correlated with pathological grading and staging（ P〈0. 05）. In HBe Ag-negative patients,serum HBV DNA was positively correlated with the pathological grading and staging（ P〈0. 01）. In both HBe Ag-positive and HBe Ag-negative patients,the area under ROC curve of the regression model for predicting different pathological states was significantly larger than that of the diagonal reference（ P〈0. 01）. In HBe Ag-positive patients,the optimal cut-offs of predictive probability in the regression model for predicting advanced fibrosis and serum HBs Ag for diagnosis of advanced fibrosis were ≥0. 185 and ≤ 3. 797 log10 IU / ml respectively, and the corresponding sensitivities, specificities,accuracies were 0. 886,0. 646,0. 706 and 0. 800,0. 660,0. 695 respectively. In HBe Ag-negative patients,the optimal cut-offs of predictive probability in the regression model for predicting significant fibrosis and serum HBV DNA for diagnosis of significant fibrosis were ≥0. 603 and ≥3. 095 log10 IU / ml respectively,and the corresponding sensitivities,specificities,accuracies were 0. 636,0. 720,0. 668 and 0. 669,0. 653,0. 663,respectively. Conclusion Logistic regression models based on age and serum HBs Ag,HBV DNA can enhance the efficacy of serum HBs Ag and HBV DNA for diagnosis of pathological states in patients with chronic hepatitis B.

关 键 词：乙型肝炎表面抗原 乙型肝炎病毒DNA 定量检测 慢性乙型肝炎 肝纤维化 Logistic回归分析 

分 类 号：R575.2[医药卫生—消化系统]