King指数无创诊断慢性HBV感染患者肝纤维化程度的预测价值  

Predictive value of King’s index in noninvasive diagnosis of liver fibrosis degrees in patients with chronic hepatitis B virus infection

作　　者：徐洪海 郜玉峰[1] XU Honghai;GAO Yufeng(Department of Pathology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院病理科,合肥230022

出　　处：《安徽医学》2020年第5期505-509,共5页Anhui Medical Journal

基　　金：国家自然科学基金(项目编号:81900554);中央引导地方科技创新项目(项目编号:201907d07050008)。

摘　　要：目的评价无创诊断模型King指数对慢性HBV患者纤维化程度的预测价值。方法选择185例于2018年7月至2019年11月在安徽医科大学第一附属医院接受治疗,谷丙转氨酶(ALT)小于2倍正常值上限的慢性HBV患者进行常规实验室检查及肝脏活检检查,分析King指数、FIB-4和APRI与肝纤维化病理分期的相关性,并绘制三者的受试者工作特征曲线(ROC),探究King指数对HBV患者肝脏纤维化程度的预测价值。结果King指数、FIB-4和APRI与肝纤维化程度的相关系数分别为0.488、0.404和0.440。King指数、FIB-4和APRI对显著肝纤维化(肝纤维化分期≥S2期)的曲线下面积(AUC)分别为0.764、0.710和0.737,对严重肝纤维化(肝纤维化分期≥S3期)的AUC分别为0.774、0.732和0.746。当King指数截断值为10.946时,诊断显著肝纤维化的敏感度和特异度分别为61.05%、79.10%;当King指数的截断值为12.315时,诊断严重肝纤维化的敏感度和特异度分别为69.54%、74.67%。结论King指数对ALT小于2倍正常值上限的慢性HBV感染患者的肝纤维化具有一定的预测价值。Objective To evaluate the value of King’s score in predicting the degree of liver fibrosis in patients with chronic hepatitis B virus(HBV)infection with alanine aminotransferase(ALT)<2 times upper limit of normal(ULN).Methods A total of 185 chronic HBV infectionpatients were chosen,routine laboratory test and liver biopsy were carried out,the relevance of King’s score,FIB-4 and APRI with liver fibrosis stage were analyzed,the receiver operating characteristic curve(ROC curve)of these three was drawn,and the predicting value of King’s score was explored.Results King’s score,FIB-4 and APRI were positively correlated with liver fibrosis(r=0.488,0.404 and 0.440).The AUC of King’s score,FIB-4 and APRI in diagnosis in significant liver fibrosis was 0.76,0.71 and 0.74,respectively.The AUC of King’s score,FIB-4 and APRI in diagnosis in advanced liver fibrosis was 0.77,0.73 and 0.75,respectively.At the cut-off value of 10.946,King’s score had a sensitivity of 61.05%and a specificity of 79.10%in diagnosis of significant liver fibrosis.At the cut-off value of 12.315,King’s score had a sensitivity of 69.54%and a specificity of 74.67%in diagnosis of advanced liver fibrosis.Conclu sions King’s score has a certain predictive value of liver fibrosis in chronic HBV infection patients with ALT<2 ULN.

关 键 词：慢性乙型肝炎感染 肝脏穿刺病理诊断 肝纤维化 无创诊断模型 King指数 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]