APRI、GPRI、FIB-4在诊断慢乙肝肝脏纤维化及肝癌中的临床应用价值  

Clinical value of APRI,GPRI,FIB-4 in the diagnosis of liver fibrosis and liver cancer caused by chronic hepatitis B

作　　者：王海莉 贾因棠[1] WANG Haili;JIA Yintang(Department of Infectious Diseases,First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院感染病科,太原030001

出　　处：《山西医科大学学报》2018年第6期650-654,共5页Journal of Shanxi Medical University

摘　　要：目的探讨alanine-aminotransferase to platelet ratio index(APRI)、gamma-glutamyl transpeptidase to platelet ratio index(GPRI)、fibrosis 4 score(FIB-4)三种模型在诊断慢性乙型肝炎(chronic hepatitis B,CHB)所致肝纤维化及肝癌中的临床应用价值。方法选取于山西医科大学第一医院2014-03~2017-08曾接受过肝组织穿刺活检或曾行肝脏切除有肝组织病理检查结果的63例CHB患者为研究对象,收集符合条件患者的相关病例资料,以病理结果为标准,将研究对象分为轻度肝纤维化组(S0-1)、中度肝纤维化组(S2-3)、肝硬化组(S4)、肝癌组。计算各组患者的APRI、GPRI、FIB-4值。对APRI、GPRI、FIB-4三种无创诊断模型与肝组织病理结果的相关性检验采用Spearman相关分析,应用受试者工作特征曲线(ROC)分析方法计算曲线下面积(AUC),以评价三种模型对各分组的诊断效能,并确定诊断的最佳截断值、敏感度和特异度。采用Logistic回归分析构建联合预测因子,并采取AUC评价三种模型联合对肝纤维化及肝癌诊断的准确性。结果 APRI、FIB-4、GPRI值与肝纤维化分期及肝癌间均有良好的相关性,相关系数r分别为0.612,0.751,0.469,均P<0.05。APRI、GPRI、FIB-4均对肝硬化组(S4)及肝癌组有较好的诊断效能,而三种模型联合时,对轻度肝纤维化组(S0-S1)、明显肝纤维化组(S2-S3)、肝硬化组(S4)、肝癌组的诊断效能均有所提高。结论 APRI、GPRI、FIB-4指标联合对肝纤维化及肝癌的诊断与病理诊断价值趋近,且对肝纤维化的早期诊断、早期治疗有较高的指导价值。Objective To evaluate the clinical value of alanine-aminotransferase to platelet ratio index（ APRI）,gamma-glutamyl transpeptidase to platelet ratio index（ GPRI）,fibrosis 4 score（ FIB-4） in the diagnosis of liver fibrosis and liver cancer caused by chronic hepatitis B. Methods A total of 63 patients with CHB undergoing liver biopsy or hepatic pathological test after hepatectomy in the First Hospital of Shanxi Medical University from March 2014 to August 2017 were enrolled in this study. The relevant clinical data were collected and divided into four groups based on hepatic tissue pathological results： mild liver fibrosis（ S0-1） group,significant fibrosis（ S2-3） group,cirrhosis（ S4） group and liver cancer group. APRI,GPRI,FIB-4 were calculated. The correlation between the three noninvasive diagnostic models of APRI,GPRI,FIB-4 and liver histopathology was analyzed by Spearman correlation analysis. AUC was used to evaluate the diagnostic efficiency（ optimal cut-off figure,sensitivity and specificity） of APRI,GPRI,FIB-4. Logistic regression analysis was used to construct the combined predictors and AUC was used to evaluate the accuracy of combined indicators in the diagnosis of liver fibrosis and liver cancer. Results APRI,FIB-4 and GPRI all showed good correlation with liver histopathology,and their correlation coefficients were 0. 612,0. 751 and 0. 469,respectively（ P〈0. 05）. APRI,GPRI and FIB-4 all had a better diagnostic efficiency on cirrhosis（ S4） and liver cancer,and the combination of the three models improved the diagnostic efficiency for S0-S1,S2-S3,S4 and liver cancer. Conclusion The diagnostic value of the combination of APRI,GPRI and FIB-4 for the liver fibrosis and liver cancer is close to that of pathology,which has a great guiding value to the early diagnosis and treatment of liver fibrosis.

关 键 词：乙肝 肝纤维化 肝癌 无创诊断模型 

分 类 号：R575[医药卫生—消化系统]