γ-谷胺酰转肽酶与白蛋白关系模型对慢性乙型肝炎肝纤维化的诊断评价  

Diagnosis of Liver Fibrosis in Patients with Chronic Hepatitis B Infection by the Model of Relationship between Gamma-Glutamyl Transpeptidase and Albumin

作　　者：许晴晴 葛善飞[1] 余燕青[2] 熊英[1] XU Qing-qing;GE Shan-fei;YU Yan-qing;XIONG Ying(Department of Infection,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Pathology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院感染科,南昌330006 [2]南昌大学第一附属医院病理科,南昌330006

出　　处：《实用临床医学（江西）》2019年第9期4-7,I0001,共5页Practical Clinical Medicine

摘　　要：目的依据临床及血清学结果,构建一个可用于诊断慢性乙型肝炎患者肝纤维化的无创模型。方法回顾性研究行肝活检术的61例慢性乙型肝炎患者的临床资料,分析26项常见的临床及血清指标,如体质量、性别、年龄、血生化、乙型肝炎病毒学标志物、凝血功能、HBV-DNA、甲胎蛋白、血常规等变量。选取与肝纤维化独立相关的变量,创立一个肝纤维化的诊断模型,采用受试者工作特点曲线(ROC)评估对肝纤维化诊断的价值,并与其他无创模型(GRR、FCI)比较其对慢性乙型肝炎显著性(S2—S4)及进展性(S3—S4)肝纤维化的诊断能力。结果γ-谷胺酰转肽酶(GGT)及碱性磷酸酶(ALP)、白蛋白(Alb)与肝纤维化程度变化均有统计学意义,P<0.05。GGT、ALP与肝纤维化变化呈正性相关,相关系数分别为0.423、0.332;而Alb与肝纤维化分期呈负性相关关系,相关系数为-0.337,根据双因素逐步分析得出只有Alb和GGT与肝纤维化程度相关(P=0.008,P=0.001),并建立一个由GGT、Alb组成的模型——GA,并得出GA=3.231+0.046×GGT-0.070×Alb。对于显著性肝纤维化,GA、GPR、FCI模型曲线下面积分别为0.776(95%CI0.643~0.908)、0.774(95%CI0.635~0.913)和0.690(95%CI0.550~0.831),其敏感度、特异度、截断值分别为75.00%、82.90%、0.58,65.00%、87.80%、0.53和95.00%、36.60%、0.32;对于进展性肝纤维化,GA、GPR、FCI模型曲线下面积分别为0.855(95%CI0.726~0.984)、0.769(95%CI0.610~0.928)和0.709(95%CI0.564~0.854),其敏感度、特异度、截断值分别为90.90%、76.00%、0.67,63.60%、90.00%、0.54和90.90%、46.00%、0.37。结论GA模型对慢性乙型肝炎肝纤维化具有一定的诊断价值。Objective To construct a non-invasive model for the diagnosis of liver fibrosis in patients with chronic hepatitis B based on clinical and serological results. Methods Clinical data of 61 patients with chronic hepatitis B who underwent liver biopsy were retrospectively studied to analyze the 26 common clinical and serum indicators,such as body weight,gender,age,blood biochemistry,hepatitis B virological markers,coagulation function,HBV-DNA,alpha fetal protein,blood routine and other variables.Liver fibrosis-related variables were selected to establish a diagnostic model.The receiver operating characteristic curve(ROC) was used to evaluate the diagnostic value.The abilities to diagnose significant fibrosis(S2-S4) and progressive fibrosis(S3-S4) were compared with other non-invasive models(GRR and FCI). Results The gamma-glutamyl transpeptidase(GGT) and alkaline phosphatase(ALP) were positively correlated with liver fibrosis,and the correlation coefficients were 0.423 and 0.332,respectively.The albumin(Alb) was negatively related to liver fibrosis,and the correlation coefficient was -0.337.According to the two-factor stepwise analysis,only Alb and GGT were associated with liver fibrosis( P=0.008 and 0.001,respectively).Furthermore,a model GA consisting of GGT and Alb was established,and GA=3.231+0.046×GGT-0.070×Alb was obtained.For significant fibrosis,the areas under the GA,GPR,and FCI model curves were 0.776(95.00% CI 0.643-0.908),0.774(95.00% CI 0.635- 0.913 ) and 0.690(95.00% CI 0.550-0.831), respectively .The sensitivity,specificity and cutoff value were,respectively,75.00%,82.90% and 0.58 for GA,65.00%,87.80% and 0.53 for GPR,and 95.00%,36.60% and 0.32 for FCI.For progressive fibrosis,the areas under the GA,GPR and FCI model curves were 0.855(95.00% CI 0.726- 0.984),0.769(95.00% CI 0.610-0.928) and 0.709(95.00% CI 0.564-0.854),respectively.The sensitivity,specificity and cutoff value were,respectively,90.90%,76.00% and 0.67 for GA, 63.60%,90.00% and 0.54 for GPR,and 90.90%,46.00% and 0.37 for FCI. Conclusio

关 键 词：γ-谷胺酰转肽酶 白蛋白 肝纤维化 GA模型 无创诊断模型 慢性乙型肝炎 

分 类 号：R512.62[医药卫生—内科学]