Forns指数对慢性乙型肝炎病毒感染者肝纤维化无创诊断的价值  

Value of Forns index for noninvasive diagnosis of liver fibrosis in chronic hepatitis B patients

作　　者：饶建国[1,2] 郜玉峰[1] 叶珺[1] 魏艳艳[1] 李芳[1] 邹桂舟[1] 

机构地区：[1]安徽医科大学第二附属医院肝病科,安徽省合肥市230601 [2]六安市人民医院感染病科,安徽省六安市237005

出　　处：《世界华人消化杂志》2015年第11期1818-1824,共7页World Chinese Journal of Digestology

基　　金：安徽省教育厅自然科学基金资助项目;No.KJ2014A107~~

摘　　要：目的:探讨Forns指数对慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者肝纤维化程度的无创诊断价值.方法:对361例慢性HBV感染患者进行肝穿刺病理检查,并同时检测穿刺当天患者的肝功能、HBV五项指标、HBV DNA和血常规等指标,根据Forns计算公式得出F o r n s值,以肝脏病理结果为金标准绘制Forns指数的受试者工作特征曲线(receiver operating characteristic curve,ROC),计算曲线下面积(area under curve,AUC),评价其对显著纤维化,严重纤维化和肝硬化的预测价值.结果:随着肝纤维化程度的加重,患者的白蛋白、HBV DNA水平、胆固醇和血小板逐渐降低;而年龄、谷氨酰转肽酶、球蛋白、谷草转氨酶水平和Forns指数随肝纤维化程度加重而逐渐升高,差异有统计学意义(P<0.05).Spearman等级相关性分析显示,F o r n s指数与肝纤维化分期呈显著正相关性(r=0.451,P<0.001).Forns指数以4.873为截断值,诊断显著肝纤维化的灵敏度68.7%,特异度70.3%;以5.432为截断值,诊断严重肝纤维化的灵敏度70.2%,特异度71.8%;以6.289分值为截断值,诊断肝硬化的灵敏度76.7%,特异度81.1%.结论:Forns指数是一种简单、有效的无创肝纤维化评价指标,可使大部分慢性HBV感染患者避免肝穿活检.AIM： To assess the value of Forns index for noninvasive diagnosis of liver fibrosis inpatients with chronic hepatitis B（CHB）. METHODS： The severity of liver fibrosis in 361 CHB patients was assessed by liver biopsy, and routine laboratory indicators were examined to calculate the Forns index. The diagnostic value of Forns index in significant fibrosis, advanced fibrosis and cirrhosis was assessed using the area under the receive operating characteristic curve analysis. RESULTS： With the increase in the severity of liver fibrosis, the mean age and mean levels of γ-glutamyl transpeptidase（GGT）, globulin（GLB）, aspartate transaminase（AST） and Forns index gradually increased in patients with chronic HBV infection, and the mean levels of albumin（ALB）, HBV DNA, cholesterol and platelet（ PLT） gradually decreased, which had significant differences between the S1-S4 groups（P 〈 0.05）. The Spearman rank correlation analysis showed that there was a significantly positive correlation between Forns index and liver fibrosis stage（r = 0.451, P 〈 0.001）. The cutoff value of Forns index was 4.873 for significant liver fibrosis, with a sensitivity of 68.7% and a specificity of 70.3%. The cutoff value of Forns index was 5.432 for advanced liver fibrosis, with a sensitivity of 70.2% and a specificity of 71.8%. The cutoff value of Forns index was 6.289 for cirrhosis, with a sensitivity of 76.7% and a specificity of 81.1%. CONCLUSION： Forns index is a simple and effective noninvasive model to predict the severity of liver fibrosis.

关 键 词：Forns指数 肝纤维化 乙型肝炎病毒 肝脏穿刺 

分 类 号：R512.62[医药卫生—内科学]