APRI、FIB-4和GPR对慢性乙型肝炎肝脏炎症程度的诊断价值  

Value of aspartate aminotransferase-to-platelet ratio index,fibrosis-4,and gamma-glutamyl transpeptidase-to-platelet ratio in diagnosis of liver inflammation grade in patients with chronic hepatitis B

作　　者：周新兰[1] 马鑫[2] 王雁冰[1] 李秀芬[1] 黄丹[1] 陆伟[1] 张占卿[1] 丁荣蓉[1] ZHOU Xinlan;MA Xin;WANG Yanbing;LI Xiufen;HUANG Dan;LU Wei;ZHANG Zhanqing;DING Rongrong(Department of Hepatobiliary Medicine,Shanghai Public Health Clinical Center Affiliated to Fudan University,Shanghai 201508,China;Department of Ultrasound,Shanghai Public Health Clinical Center Affiliated to Fudan University,Shanghai 201508,China)

机构地区：[1]上海市公共卫生临床中心肝胆内科,上海201508 [2]上海市公共卫生临床中心超声科,上海201508

出　　处：《临床肝胆病杂志》2021年第9期2066-2070,共5页Journal of Clinical Hepatology

摘　　要：目的评价AST/PLT指数(APRI)、纤维化指数(FIB-4)、GGT/PLT比值(GPR)对慢性乙型肝炎(CHB)患者肝组织炎症分级的诊断价值。方法选取2016年10月—2019年10月在上海市公共卫生临床中心住院期间接受经皮肝组织活检及常规实验室检查的CHB患者545例。依据Scheuer方法进行炎症分级(G),并依据临床指标分别计算APRI、FIB-4、GPR。正态分布计量资料2组间比较采用t检验;非正态分布计量资料2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ2检验。两变量间相关性应用Spearman相关分析。血清无创诊断模型对肝组织炎症活动度分级的诊断性能评价采用受试者工作特征曲线法(ROC曲线)。采用Delong检验比较血清无创模型的ROC曲线下面积(AUC)。结果545例患者中肝组织炎症分级G0~1级224例,G2级209例,G3级112例。Spearman相关分析结果显示,APRI、FIB-4和GPR值与肝组织炎症分级均呈正相关(r值分别为0.611、0.470、0.563,P值均<0.001)。APRI、FIB-4和GPR诊断肝炎症分级G≥2的AUC分别为0.820、0.719、0.782;临界值分别为0.53、1.48和0.20;GPR诊断G≥2的效能优于FIB-4(P=0.01),但略低于APRI(P=0.048)。基于ALT水平分层分析,在ALT≤1×ULN组、1~2×ULN组和2~5×ULN组,APRI诊断G≥2的AUC分别为0.847、0.786和0.724,FIB-4分别为0.777、0.729和0.626,GPR分别为0.801、0.781和0.607;亚组结果显示除在2~5×ULN组GPR诊断效能低于APRI(P=0.042),其余ALT分层组GPR和APRI、FIB-4诊断性能相似。APRI、FIB-4和GPR诊断肝炎症分级G≥3的AUC分别为0.791、0.725、0.801;临界值分别为0.66、1.49和0.25;GPR诊断炎症分级G≥3的效能与APRI相似,但优于FIB-4(P=0.006)。基于ALT水平分层分析,在ALT≤1×ULN组、1~2×ULN组和2~5×ULN组,APRI诊断G≥3的AUC分别为0.900、0.742和0.693,FIB-4分别为0.874、0.683和0.644,GPR分别为0.890、0.805和0.668。亚组结果显示除在1~2×ULN组GPR诊断效能优于FIB-4(P=0.015),其余ALT分层组GPR和APRI�Objective To investigate the value of aspartate aminotransferase-to-platelet ratio index(APRI),fibrosis-4(FIB-4)score,and gamma-glutamyl transpeptidase-to-platelet ratio(GPR)in diagnosis of liver inflammation grade in patients with chronic hepatitis B(CHB).Methods A total of 545 patients with CHB who underwent percutaneous liver biopsy and routine laboratory examinations during hospitalization in Shanghai Public Health Clinical Center Affiliated to Fudan University from October 2016 to October 2019 were enrolled.Inflammation grade(G)was determined according to the Scheuer scoring system,and APRI,FIB-4,and GPR were calculated based on related clinical indicators.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.A Spearman correlation analysis was used to investigate the correlation between two variables.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance of the three serum noninvasive diagnostic models in determining liver inflammation grade,and the Delong test was used for comparison of the area under the ROC curve(AUC).Results Among the 545 patients,224 had grade G0-1 liver inflammation,209 had grade G2 liver inflammation,and 112 had grade G3 liver inflammation.The Spearman correlation analysis showed that APRI,FIB-4,and GPR were positively correlated with liver inflammation grade(r=0.611,0.470,and 0.563,all P<0.001).APRI,FIB-4,and GPR had an AUC of 0.820,0.719,and 0.782,respectively,in the diagnosis of G≥2 liver inflammation,with optimal cut-off values of 0.53,1.48,and 0.20,respectively;for the diagnosis of G≥2 liver inflammation,GPR had a better performance than FIB-4(P=0.01)and a slightly lower performance than APRI(P=0.048).The stratified analysis based on alanine aminotransferase(ALT)level showed that in the≤1×upper lim

关 键 词：慢性乙型肝炎 炎症 诊断 

分 类 号：R512.62[医药卫生—内科学]