非创伤性诊断模型在慢性乙型肝炎患者肝纤维化中的应用  

Role of noninvasive diagnostic model for liver fibrosis in patients with chronic hepatitis B

作　　者：侯丽[1] 于璐 牛瑶[1] 张媛 王亮[1] HOU Li;YU Lu;NIU Yao;ZHANG Yuan;WANG Liang(Department of Clinical Laboratory,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang,China;Department of Clinical Laboratory,Tumor Hospital of Xinjiang Medical University,Urumqi 830000,Xinjiang,China;Department of Clinical Laboratory the Second People's Hospital of Kashi of Xinjiang Uygur Autonomous Region,Kashi 844000,Xinjiang,China)

机构地区：[1]新疆医科大学第一附属医院医学检验中心,新疆乌鲁木齐830054 [2]新疆医科大学附属肿瘤医院检验科,新疆乌鲁木齐830000 [3]新疆维吾尔自治区喀什地区第二人民医院检验科,新疆喀什844000

出　　处：《检验医学》2018年第10期888-893,共6页Laboratory Medicine

基　　金：新疆维吾尔自治区自然科学基金资助项目(2016D01C293)

摘　　要：目的用非创伤性指标建立慢性乙型肝炎(CHB)患者肝纤维化诊断模型,并评价建立的模型的诊断价值。方法检测270例行肝脏组织病理学检查的CHB患者的肝纤维化血清学标志物[血小板(PLT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TB)、白蛋白(Alb)、白蛋白/球蛋白(A/G)比值、红细胞分布宽度(RDW)、凝血酶原活动度(PTA)、纤维蛋白原(Fib)、乙型肝炎病毒e抗原(HBeAg)]水平。分析这些检测指标与CHB患者肝纤维化的相关性。采用Logistic回归分析建立诊断模型,采用受试者工作特征(ROC)曲线分析其诊断价值,并与已建立的诊断模型(APRI、FIB-4、AAR、GPR、RPR)进行比较。结果通过Logistic回归分析逐一分析各项指标,得出回归方程建立新的诊断模型AFPPR:AFPPR=1/[1+EXP(-2.584-A/G比值×1.426-PLT×0.013-PTA×0.016-Fib×0.605+RDW×0.364)]。ROC曲线分析显示,AFPPR诊断显著肝纤维化的曲线下面积(AUC)为0.80,明显大于其他5个诊断模型的AUC(P<0.01),AAR对于显著肝纤维化及严重肝纤维化基本无诊断价值(P>0.05);AFPPR诊断严重肝纤维化的AUC为0.76,与其他5个模型的AUC比较,除AAR模型(P=0.000)外,差异均无统计学意义(P>0.05)。结论建立的AFPPR诊断模型可用于诊断CHB患者的显著肝纤维化,可作为临床动态监测肝纤维化的补充性证据。Objective To establish the noninvasive diagnostic model for liver fibrosis in patients with chronic hepatitis B(CHB),and to investigate the role for diagnosis.Methods Serum liver fibrosis markers[platelet(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyltransferase(GGT),alkaline phosphatase(ALP),total bilirubin(TB),albumin(Alb),albumin to globulin(A/G)ratio,red blood cell distribution width(RDW),prothrombin time activity(PTA),fibrinogen(Fib)and hepatitis B e antigen(HBeAg)]were determined in 270 patients with CHB undergoing liver biopsy.The correlation between these indices and liver fibrosis stage of CHB patients was analyzed.Logistic regression analysis was performed to establish a diagnostic model,and the results were analyzed by receiver operating characteristic(ROC)curve and compared with established diagnostic models(APRI,FIB-4,AAR,GPR and RPR).Results By Logistic regression analysis,the indices were analyzed,and the regression equation for new diagnostic model AFPPR,which was AFPPR=1/[1+EXP(-2.584-A/G ratio×1.426-PLT×0.013-PTA×0.016-Fib×0.605+RDW×0.364)],was set up.The area under curve(AUC)of AFPPR for the diagnosis of liver fibrosis was 0.80,which was bigger than those of the other 5 diagnostic models(P<0.01).AAR had no diagnostic value for significant and severe liver fibrosio(P>0.05).The AUC of AFPPR for severe liver fibrosis was 0.76,which was bigger than those of the other 5 diagnostic models.Compared with the AUC of the other 5 diagnostic models,there was no statistical significance,except for AAR(P=0.000).Conclusions The established AFPPR diagnostic model for liver fibrosis can be used as clinical supplementary reference on the dynamic observation of liver fibrosis.

关 键 词：非创伤性诊断模型 肝脏纤维化 慢性乙型肝炎 

分 类 号：R446.1[医药卫生—诊断学]