血液指标在慢性乙型肝炎肝纤维化诊断中的价值  

Value of blood indicators in diagnosis of liver fibrosis in patients with chronic hepatitis B

作　　者：杨晴[1] 颜迎春[1] 张明香[1] 刘丹阳[1] 辛晓丽[1] 

机构地区：[1]沈阳市第六人民医院感染科,辽宁省沈阳市110006

出　　处：《世界华人消化杂志》2015年第15期2450-2456,共7页World Chinese Journal of Digestology

摘　　要：目的:评价血液指标在慢性乙型肝炎(chronic hepatitis B,CHB)肝纤维化诊断中的价值.方法:选择入院并进行肝活检的CHB患者522例.在模型组(313例)利用Logistic回归分析等构建预测模型,并在验证组(209例)中检验模型的价值.结果:在模型组,肝纤维化4项指标中透明质酸(hyaluronic acid,HA)、Ⅳ型胶原(collagen type Ⅳ,CⅣ)与肝纤维化分期相关.其他指标中血小板(platelet,PLT)(OR=0.227)、γ-谷氨酰转肽酶(γ-glutamyl transferase,GGT)(OR=1.515)、血清白蛋白(albumin,Alb)(OR=0.438)和年龄(OR=1.204)是与肝纤维化分期相关的独立指标.以此4项指标建立的模型诊断S2-4、S3-4、S4的ROC曲线下面积(area under receiver operating characteristic curve,AUROC)为0.901、0.904、0.893.分别取界值为0.040、0.051、0.060时,灵敏度和特异度为82.5%和85.4%、84.3%和82.5%、88.0%和77.4%,准确率为83.3%、83.0%、79.2%.验证组的AUROC与模型组比较差异无统计学意义.结论:基于血液指标PLT、GGT、Alb和年龄建立的模型能较准确检测肝纤维化和早期肝硬化,减少肝活检的数量.AIM：To evaluate the value of blood indicators in diagnosing liver fibrosis in patients with chronic hepatitis B（CHB）.METHODS：Clinical data for 522 patients with CHB who received liver biopsy at the Sixth People’s Hospital of Shenyang city were collected.These patients were randomly allocated to a model group（n = 313） and a validation group（n- 209）.In the model group,Logistic regression analysis was performed to determine the factors independently correlated with liver fibrosis stage（S）,and a diagnostic model was then established.The model was also applied to the validation group to test its accuracy.RESULTS：In the four indicators for liver fibrosis,hyaluronic acid（HA） and collagen type IV（CIV） were correlated with liver fibrosis stage.Platelet count（PLT）（OR =0.227）,γ-glutamyl transferase（GGT）（OR =1.515）,albumin（Alb）（OR = 0.438） and age（OR = 1.204） were independently correlated with liver fibrosis stage.The values of the area under receiver operating characteristic curve（AUROC） of the model based on these four independent factors in diagnosing S2-4,S3-4 and S4（early liver cirrhosis） were 0.901,0.904 and 0.893,respectively.Taking 0.040,0.051 and 0.060 as cut-off values,respectively,the sensitivity and specificity were 82.5%and 85.4%,84.3%and 82.5%,and 88.0%and77.4%,respectively.The accuracy was 83.3%,83.0%,and 79.2%,respectively.AUROC for the validation group was similar to that for the model group.CONCLUSION：The model based on PLT,GGT,Alb and age can effectively predict liver fibrosis and early liver cirrhosis.

关 键 词：肝纤维化 慢性乙型肝炎 诊断 

分 类 号：R512.62[医药卫生—内科学]