诊断模型对ALT正常值上限2倍以下慢性HBV感染者治疗指征的判断价值  

Analysis on the judgment values of three non-invasive score systems( LIF-5,APRI and FIB-4) for treatment indication in chronic HBV infected patients with ALT less than two times of upper limits of normal

作　　者：蒋素文[1] 胡爱荣[1,2] 颜华东[1,2] 金珊珊[2] 胡耀仁[1,2] 

机构地区：[1]宁波市第二医院肝病诊治中心,浙江宁波315010 [2]宁波大学医学院研究生院,浙江宁波315211

出　　处：《中华全科医学》2017年第4期558-561,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生省部培育计划项目(2014PYA018);浙江省区域专病中心建设专科(感染科)项目(2014-98);浙江省宁波市科技计划社发重大项目(2016-C51005);宁波市医学科技计划项目(2016C04)

摘　　要：目的对比分析诊断模型(LIF-5、APRI及FIB-4)对丙氨酸转移酶(ALT)<2×正常值上限(ULN)慢性乙型肝炎病毒(HBV)感染者治疗指征(≥G2或≥S2)的判断价值。方法收集1 135例接受肝脏穿刺活检术患者的临床资料,分为<G2和<S2组、≥G2或≥S2组,构建诊断模型LIF-5,评估LIF-5与APRI、FIB-4对治疗指征的判断价值。结果≥G2或≥S2组患者占44.49%;该组男性和HBe Ag阴性的构成、年龄、ALT、AST、APRI及FIB-4的平均值均高于<G2和<S2组,白蛋白/球蛋白(A/G)、白细胞、血小板(PLT)的平均值均低于<G2和<S2组,差异有统计学意义(P<0.01)。诊断模型LIF-5=0.725+0.005×年龄+0.003×ALT+0.004×AST-0.201×(A/G)-0.002×PLT(109/L)。LIF-5分布的集中程度高于APRI和FIB-4,且判断价值优于APRI和FIB-4。LIF-5、APRI和FIB-4判断治疗指征的截断值分别为0.46、0.53和1.22。当LIF-5≤0.30时,敏感度96.8%、阴性预测值91.8%;当LIF-5>0.75时,特异度97.3%、阳性预测值87.1%。结论有较高比例的ALT<2×ULN慢性HBV感染者存在明显肝脏疾病进展,诊断模型LIF-5对治疗指征的判断有较好的价值,值得推广。Objective To comparatively analyze the judgment values of three non-invasive score systems（ LIF-5,APRI and FIB-4）,which were based on common indicators,for treatment indication（ ≥G2 or ≥S2） in chronic HBV infected patients with ALT less than two times of upper limits of normal（ ULN）. Methods The data of liver pathology and clinical characteristics in 1 135 chronic HBV infected patients with ALT 〈2 × ULN were analyzed retrospectively. Patients were divided into（ 〈G2 and〈 S2） group and（ ≥G2 or ≥S2） group. Polynomial regression analysis was carried out to construct the diagnostic model（ LIF-5）. The judgment values of LIF-5,APRI and FIB-4 for treatment indication were comparatively analyzed. Results There were 505 cases（ 44. 49%） with liver inflammation pathological grading ≥G2 or fibrosis stage ≥S2. The constituent ratios of male patients and HBe Ag negative,the average age,the average values of ALT,AST,APRI and FIB-4 in（ ≥G2 or ≥S2） group were higher than those in（ G2 and S2） group,and the average values of albumin-globulin ratio（ A/G）,white blood cell and platelet（ PLT） were lower,and the differences were statistically significant（ P〈0. 01）. The diagnostic model（ LIF-5） = 0. 725 ＋ 0. 005 × age（ y） ＋ 0. 003 × ALT ＋ 0. 004 × AST-0. 201 ×（ A/G）-0. 002 × PLT（ 10^9/L）. The concentration degree and the judgment value of LIF-5 were higher than APRI and FIB-4. The cutoff values for treatment indication of LIF-5,APRI and FIB-4 were 0. 46,0. 53 and 1. 22,respectively. When the LIF-5 was ≤0. 30 for treatment indication,the sensitivity and negative predictive value（ NPV） were96. 8% and 91. 8%. When the LIF-5 was〉 0. 75 for treatment indication,the specificity and positive predictive value（ PPV） were 97. 3% and 87. 1%. Conclusion There are still structural damage with liver inflammation ≥G2 or fibro sis ≥S2 in 44. 49 per cent chronic HBV infected patients with ALT〈 2 × ULN. The non-invasive score system with L

关 键 词：乙型肝炎 慢性 LIF-5 APRI FIB-4 病理学 诊断试验评价 

分 类 号：R512.62[医药卫生—内科学]