GGT/PLT比值对广东地区慢性乙型肝炎患者肝纤维化分期的预测价值  

Value of gamma-glutamyl transpeptidase-to-platelet ratio in predicting liver fibrosis stage in chronic hepatitis B patients in Guangdong,China

作　　者：黄春明[1] 杨湛[1] 聂玉强[2] 胡中伟[1] 周永健[2] 詹远京[1] 郭家伟[1] 余卫华[1] HUANG Chunming;YANG Zhan;NVIE Yuqiang(Department of Gastroenterology,Guangzhou 8th People＇s Hospital,Guangzhou 510060,China)

机构地区：[1]广州市第八人民医院消化内科,广州510060 [2]广州市第一人民医院消化内科广州市消化病重点实验室,广州510180

出　　处：《临床肝胆病杂志》2018年第6期1204-1208,共5页Journal of Clinical Hepatology

基　　金：广州市卫生局项目(2014KP000027)

摘　　要：目的探讨GGT/PLT比值(GPR)预测广东地区慢性乙型肝炎患者肝纤维化分期的价值。方法收集2010年1月-2016年12月于广州市第八人民医院行肝活组织检查诊断为慢性乙型肝炎的患者501例,其中HBe Ag阳性335例,HBe Ag阴性166例。分析比较GPR、GGT、AST/PLT指数(APRI)及FIB-4对肝纤维化分期(F1~F4)的预测价值。Spearman相关系数分析诊断模型指标与肝纤维化分期的相关性,采用受试者工作特征(ROC)曲线下面积评估各模型对肝纤维化分期的预测价值。结果肝活组织病理检查作为金标准,F1~F4期患者分别为141、183、139、38例。Spearman相关分析显示,HBe Ag阳性和HBe Ag阴性患者GGT、GPR、APRI和FIB-4均与肝纤维化分期呈正相关(r值分别为0.459、0.526、0.320、0.470、0.272、0.366、0.288、0.388,P值均<0.001),PLT与肝纤维化分期呈负相关(r值分别为-0.333、-0.349,P值均<0.001)。ROC曲线分析结果显示,GPR对于HBe Ag阳性慢性乙型肝炎患者明显肝纤维化(≥F2)、进展期肝纤维化(≥F3)及早期肝硬化(F4)的预测价值优于GGT和APRI(P值均<0.05),而与FIB-4的预测价值相近(P值均>0.05);GPR对于HBe Ag阴性慢性乙型肝炎患者明显肝纤维化(≥F2)的预测价值优于GGT和APRI(P值均<0.05),对进展期肝纤维化(≥F3)的预测价值优于GGT(P<0.05),而对早期肝硬化(F4)的预测价值与GGT、APRI、FIB-4相近(P值均>0.05)。结论 GPR可以作为广东地区慢性乙型肝炎患者肝纤维化分期的无创生化预测指标,尤其是对于HBe Ag阳性患者,其预测价值与FIB-4相近,亦不亚于APRI。Objective To investigate the value of gamma-glutamyl transpeptidase-to-platelet ratio（GPR） in predicting liver fibrosis stage in chronic hepatitis B（CHB） patients in Guangdong,China. Methods A total of 501 patients who were diagnosed with CHB by liver biopsy in Guangzhou 8 th People＇s Hospital from January 2010 to December 2016 were enrolled,among whom 335 had HBe Ag-positive CHB and 166 had HBe Ag-negative CHB. The value of GPR,gamma-glutamyl transpeptidase（GGT）,aspartate aminotransferase-to-platelet ratio index（APRI）,and fibrosis-4（FIB-4） in predicting liver fibrosis stage（F1-F4） was analyzed. The Spearman correlation coefficient was used to analyze the correlation between diagnostic models and liver fibrosis stage,and the area under the receiver operating characteristic（ROC） curve（AUC） was used to evaluate the value of each model in predicting liver fibrosis stage. Results With liver biopsy as the gold standard,of all patients,141 had F1 stage,183 had F2 stage,139 had F3 stage,and 38 had F4 stage disease. The Spearman correlation analysis showed that in HBe Ag-positive and HBe Ag-negative patients,GGT,GPR,APRI,and FIB-4 were positively correlated with liver fibrosis stage（r = 0. 459,0. 526,0. 320,0. 470,0. 272,0. 366,0. 288,and 0. 388,all P 0. 001）,and platelet count（PLT）was negatively correlated with liver fibrosis stage（r =-0. 333 and-0. 349,both P 0. 001）. The ROC curve analysis showed that compared with GGT and APRI,GPR had a significantly better value in predicting marked fibrosis（≥F2）,advanced fibrosis（≥F3）,and early cirrhosis（F4）（all P 0. 05） in HBe Ag-positive CHB patients,and GPR had a similar predictive value as FIB-4（P 0. 05）; in HBe Ag-negative CHB patients,GPR had a significantly better value in predicting marked fibrosis（≥F2） than GGT and APRI（both P 0. 05） and a significantly better value in predicting advanced fibrosis（≥F3） than GGT（P 0. 05）,while GPR had a similar value as GGT,APRI,and FIB-4 in predicting

关 键 词：肝炎 乙型 慢性 肝硬化 Γ-谷氨酰转移酶 血小板 诊断 广东 

分 类 号：R575.2[医药卫生—消化系统]