PLT/GGT比值对慢性HBV感染者肝纤维化的无创诊断价值  

The noninvasive diagnostic value of PLT/GGT ratio for liver fibrosis in the patients with chronic hepatitis B virus infection

作　　者：胡庆刚[1,2] 王殷秋 郜玉峰 叶珺[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,合肥230601 [2]安徽省立医院感染病院感染病科,合肥230092

出　　处：《安徽医科大学学报》2017年第10期1568-1571,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金(编号:1608085MH164)

摘　　要：目的探讨血小板/谷氨酰转肽酶(PLT/GGT)比值无创诊断慢性HBV感染后不同肝纤维化程度的临床价值,并与FIB-4、APRI经典无创预测模型进行比较。方法收集641例进行肝穿刺病理检查的慢性HBV感染患者临床资料,以肝脏病理结果为金标准绘制PLT、GGT、PLT/GGT、APRI和FIB-4指数的受试者工作特征曲线,计算灵敏度和特异度。结果随着肝纤维化程度的加重,患者白蛋白、HBV DNA、PLT水平和PLT/GGT比值逐渐降低,而年龄、GGT、球蛋白水平和APRI、FIB-4指数逐渐升高,差异有统计学意义(P<0.05)。肝纤维化分期与PLT/GGT比值的Spearman分析显示两组呈显著负相关性(r_s=-0.475,P<0.05),相关性高于APRI和FIB-4。PLT/GGT比值以4.996为截断值,无创诊断显著肝纤维化的灵敏度和特异度为75.4%和64.8%;以4.707为截断值,诊断严重肝纤维化的灵敏度和特异度为71.4%和75.5%;以4.090为截断值,诊断肝硬化的灵敏度和特异度为71.3%和80.8%。结论PLT/GGT比值是非常适合基层医院使用的无创肝纤维化评价指标,可使大部分慢性HBV感染患者避免肝穿刺检查。Objective To explore the diagnostic value of platelet/gamma-glutamyl transferase（PLT/GGT） ratio for liver fibrosis in the patients with chronic hepatitis B infection and compare it＇s value with classical APRI and FIB- 4 noninvasive diagnosis model. Methods The liver fibrosis severity of 641 CHB patients were detected by liver bi- opsy and the routine laboratory indicators were examined and collected. The diagnostic values of PLT/GGT ratio, APRI and FIB-4 in the significant fibrosis, advanced fibrosis and cirrhosis were assessed by using receive operating characteristic curves and calculate the sensitivity and specificity. Results The levels of albumin （ALB）, HBV DNA and PLT were gradually decreased with the increase of liver fibrosis, while the age, GGT, globulin （GLB） and APRI and FIB-4 were gradually increased, the difference was statistically significant （ P 〈 O. 05 ）. The Spearman rank correlation analysis showed that PLT/GGT ratio and liver fibrosis stage was significantly positive cor- relation （rs = -0. 475, P 〈 0.05 ）, which was superior to ARPI and FIB-4 index. The cutoff value of PLT/GGT ra- tio was 4. 996 for significant liver fibrosis with sensitivity of 75.4% and specificity of 64. 8%. The cutoff value of PLT/GGT ratio was 4. 707 for advanced liver fibrosis with sensitivity of 71.4% and specificity of 75.5%. The cut- off value of PLT/GGT ratio was 4. 090 for cirrhosis with sensitivity of 71.3% and specificity of 80. 8%. Conclu- sion The PLT/GGT ratiois is a simple and effective noninvasive model to predict the severity of liver fibrosis for the doctor of primary hospital.

关 键 词：PLT/GGT比值 肝纤维化 乙型肝炎病毒 肝脏穿 刺 

分 类 号：R512.6[医药卫生—内科学]