无创模型在慢性乙型肝炎肝纤维化诊断中的价值  

Evaluation of liver fibrosis by noninvasive diagnostic indexes in patients with chronic hepatitis B

作　　者：杨晴[1] 王岩[1] 关欣 谷野[1] 李鲁平[2] 戴文颖[1] 卞丽[1] 尚宁[1] Qing Yang;Yan Wang;Xin Guan;Ye Gu;Lu-Ping Li;Wen-YingDai;Li Bian;Ning Shang(Department of Liver Diseases,The Sixth People’s Hospital of Shenyang City,Shenyang 110006,Liaoning Province,China;Department of Clinical Laboratory,The Sixth People’s Hospital of Shenyang City,Shenyang 110006,Liaoning Province,China)

机构地区：[1]沈阳市第六人民医院肝病科,辽宁省沈阳市110006 [2]沈阳市第六人民医院检验科,辽宁省沈阳市110006

出　　处：《世界华人消化杂志》2020年第22期1137-1144,共8页World Chinese Journal of Digestology

基　　金：辽宁省科技计划项目,No.2017225083;沈阳市科技计划项目,No.18-014-4-13.

摘　　要：背景肝活检是判断乙型肝炎肝纤维化的金标准,因其为有创的检查,临床应用有一定局限性,因此无创性诊断的评估受到关注.目的评价10个无创模型指数对慢性乙型肝炎肝纤维化的诊断价值.方法收集2003-06至2019-08间的慢性乙型肝炎患者1030例,所有病例均接受了肝活检,并同时检测了血液、B超等指标.按照公式计算模型的指数分别为天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST-to-ALT ratio,AAR)、AST/血小板计数比值(AST-to platelet ratio index,APRI)、年龄-血小板指数(age platelet index,API)、肝硬化判别式值(cirrhosis discriminant score,CDS)、FIB-4指数(fibrosis index based on the four factors,FIB-4)、γ-谷氨酰转肽酶/血小板计数(gamma-glutamyltranspeptidase to platelet ratio,GPR)、S指数(S-index,S)、脾脏/血小板比值指数(spleen to platelet ratio index,SPRI)、年龄-脾脏/血小板比值指数(age-spleen to platelet ratio index,ASPRI),FV(作者的模型),并利用ROC曲线下面积(area under receiver operating characteristiccurve,AUROC)评价每个模型在肝纤维化诊断中的临床价值.结果所有模型指数均与肝纤维化分期相关(r=0.215、0.382、0.629、0.449、0.612、0.618、0.654、0.658、0.707、0.775,均P<0.05).诊断F2-3的AUROC较好的为:FV(0.834)和ASPRI(0.796),灵敏度为78.8%和70.2%,特异度为74.0%和76.1%,准确率分别为76.3%和73.3%.F4为:FV(0.928)和ASPRI(0.912),灵敏度为85.4%和89.4%,特异度为85.0%和77.3%,阴性预测值为96.2%和96.5%、阴性似然比为0.172和0.137、准确率为85.1%和79.7%.结论FV和ASPRI是各项无创模型中诊断价值准确率最好的,尤其诊断早期肝硬化方面更具优势.BACKGROUND Liver biopsy is the gold standard for determining the degree of fibrosis in patients with chronic hepatitis B,but it has certain limitations in clinical application because of its invasive nature.Hence,non-invasive assessment is essential.AIM To compare the diagnostic value of ten noninvasive models indexes for liver fibrosis in patients with chronic hepatitis B.METHODS A total of 1030 patients with chronic hepatitis B admitted during June 2003 and August 2019 were enrolled in the study.All the patients received liver biopsy and blood and ultrasound examinations.The AST-to-ALT ratio,AST-to-platelet ratio index,age platelet index,cirrhosis discriminant score,fibrosis index based on four factors,gamma-glutamyltranspeptidase-to-platelet ratio,S-index,spleen-to-platelet ratio index,age-spleen-to-platelet ratio index(ASPRI),and FV(our model)were calculated.Area under the receiver operating characteristic curve(AUROC)was used to assess the clinical value of noninvasive models in diagnosis of liver fibrosis.RESULTS All the models were correlated with the stage of liver fibrosis(r=0.215,0.382,0.629,0.449,0.612,0.618,0.654,0.658,0.707,and 0.775,respectively;P<0.05).The best AUROCs of FV and ASPRI for diagnosis of significant liver fibrosis(F2-3)were 0.834 and 0.796,with sensitivities of 78.8%and 70.2%,specificities of 74.0%and 76.1%,and accuracies of 76.3%and 73.3%,respectively.The best AUROCs for diagnosis of early liver cirrhosis(F4)were 0.928 and 0.912,with sensitivities of 85.4%and 89.4%,specificities of 85.0%and 77.3%,accuracies of 85.1%and 79.7%,negative predictive values of 96.2%and 96.5%,and negative likelihood ratios of 0.172 and 0.137,respectively.CONCLUSION FV and ASPRI have better accuracies than other noninvasive diagnostic indexes in diagnosing significant liver fibrosis in patients with chronic hepatitis B,especially in the diagnosis of early liver cirrhosis.

关 键 词：肝纤维化 慢性乙型肝炎 无创性 模型 

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