血清高尔基体蛋白73、血清诊断模型APRI及声辐射力脉冲成像技术在慢性乙型肝炎患者肝纤维化程度评估中的价值  

Value of serum Golgi protein 73, serum diagnostic model APRI and acoustic pulse radiation imaging for evaluating liver fibrosis severity in patients with chronic hepatitis B

作　　者：罗双艳 钟丽坤[1] 张国[1] 蒋长秀 宋怀宇[1] LUO Shuang-yan;ZHONG Li-kun;ZHANG Guo;JIANG Chang-xiu;SONG Huai-yu(Department of Gastroenterology,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院消化内科,南宁市530021

出　　处：《广西医学》2020年第5期525-528,共4页Guangxi Medical Journal

基　　金：广西科技计划(桂科AD17129027);广西医药卫生科研课题(Z20170306)。

摘　　要：目的分析血清高尔基体蛋白73(GP73)、血清诊断模型天冬氨酸氨基转移酶和血小板比率指数(APRI)与声辐射力脉冲成像技术(ARFI)在评估慢性乙型肝炎患者肝纤维化程度中的价值。方法选取111例慢性乙型肝炎患者,根据肝纤维化病理分期分为轻度肝纤维化组36例和显著肝纤维化组75例。检测所有患者血清GP73水平及其他血清学指标,计算血清诊断模型APRI,并采用ARFI测量肝实质硬度(LS)值。分析以上3个指标与肝纤维化分期的相关性。采用受试者工作特征(ROC)曲线评价以上3个指标对显著肝纤维化的评估效能。结果显著肝纤维化组血清GP73水平、APRI及LS值高于轻度肝纤维化组(均P<0.05)。慢性乙型肝炎患者的血清GP73水平、APRI、LS值均与肝纤维化分期呈正相关(均P<0.05)。血清GP73水平、APRI、LS值、三者联合诊断显著肝纤维的曲线下面积分别为0.854、0.681、0.901、0.947(均P<0.05),三者联合的曲线下面积、特异度、灵敏度、阳性预测值及阴性预测值均高于单一指标。结论血清GP73水平、血清诊断模型APRI、ARFI对慢性乙型肝炎患者肝纤维化程度均有一定的评估价值,三者联合应用可以提高评估效能。Objective To analyze the value of serum Golgi proein 73(GP73), serum diagnostic model aspartate aminotransferase-to-platelet ratio index(APRI) and acoustic pulse radiation force imaging(ARFI) for evaluating the severity of liver fibrosis in patients with chronic hepatitis B. Methods A total of 111 patients with chronic hepatitis B were enrolled and divided into mild liver fibrosis group(n=36) and severe liver fibrosis group(n=75) according to the pathological stage of liver fibrosis. Serum GP73 level and other serological indicators were determined in all of the patients, then serum diagnostic model APRI was calculated, and ARFI was employed to measure liver stiffness(LS) value. The correlation of the three indicators mentioned above and liver fibrosis stage was analyzed. Receiver operating characteristic(ROC) curve was used to evaluate the efficiency of the three indicators mentioned above in the assessment of severe liver fibrosis. Results The serum GP73 level, APRI and LS value were higher in the severe liver fibrosis group than in the mild liver fibrosis group(all P<0.05). In patients with chronic hepatitis B, serum GP73 level, APRI, and LS value all positively correlated with liver fibrosis stage(all P<0.05). For diagnosing severe liver fibrosis, the areas under the curve of serum GP73 level, APRI, LS value, and the combination of the three indexes were 0.854, 0.681, 0.901 and 0.947, respectively(all P<0.05), and the combination of the three indexes achieved a larger area under the curve and higher specificity, sensitivity, positive predictive value and negative predictive value as compared with single index. Conclusion Serum GP73 level,serum diagnostic model APRI, and ARFI obtain a definite value in evaluating the severity of liver fibrosis in patients with chronic hepatitis B, and the combination of the three indexes can improve evaluation efficiency.

关 键 词：慢性乙型肝炎 肝纤维化 高尔基体蛋白73 天冬氨酸氨基转移酶和血小板比率指数 声脉冲辐射力成像技术 评估效能 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]