HBeAg阳性且丙氨酸转氨酶低于2倍正常值上限的慢性乙型肝炎肝纤维化无创模型的构建  

Construction of a noninvasive predictive model for liver fibrosis in chronic hepatitis B patients with HBeAg positive and alanine aminotransferase lower than 2 upper limit of normal

作　　者：汪明珊[1] 陈闪闪 黄海军[1] Wang Mingshan;Chen Shanshan;Huang Haijun(Department of Infectious Disease,Zhejiang Provincial People’s Hospital,Hangzhou 310014,China;Graduate School of Clinical Medicine,Bengbu Medical College,Bengbu 233000,Anhui Province,China)

机构地区：[1]浙江省人民医院感染病科,杭州310014 [2]蚌埠医学院研究生院,233000

出　　处：《中华临床感染病杂志》2021年第3期184-188,共5页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金(81672115)。

摘　　要：目的探寻HBeAg阳性且丙氨酸转氨酶(ALT)<2倍正常值上限(ULN)的慢性乙型肝炎(CHB)肝纤维化的影响因素,建立无创模型并验证其诊断价值。方法收集2014年10月至2020年12月浙江省人民医院感染病科收治入院的279例HBeAg阳性且ALT<2×ULN的CHB患者临床资料。根据肝穿刺病理结果进行肝纤维化分期,将S0~S1患者纳入轻度纤维化组(n=117),将S2~S4患者纳入显著纤维化组(n=162)。通过多因素Logistic回归分析,筛选肝纤维化的独立预测因素并构建回归模型,受试者工作特征(ROC)曲线及曲线下面积(AUC)评估模型的诊断价值。结果多因素Logistic回归分析显示,年龄、凝血酶原时间(PT)、天冬氨酸转氨酶(AST)、抗-HBc和HBV DNA是HBeAg阳性且ALT<2×ULN的CHB患者显著肝纤维化的独立预测指标(OR=1.055、1.365、1.027、1.231和0.763,P值均<0.05)。AUC为0.772(95%CI:0.716~0.828),当截断值为0.504,敏感度为79.5%,特异度为70.9%。APRI模型和FIB-4指数模型评估HBeAg阳性且ALT<2×ULN的CHB患者显著肝纤维化的AUC分别为0.720和0.671,均小于无创模型,差异均有统计学意义(P值均<0.05)。结论该模型能评估HBeAg阳性且ALT<2×ULN的CHB患者肝纤维化严重程度,且具有较高的诊断价值。Objective To construct a non-invasive predictive model for liver fibrosis in HBeAg positive chronic hepatitis B(CHB)patients with alanine aminotransferase(ALT)lower than 2 upper limit of normal(ULN).Methods The clinical data of 279 HBeAg positive CHB patients with ALT<2×ULN admitted in Zhejiang Provincial People’s Hospital from October 2014 to December 2020 were retrospectively analyzed.According to the pathological results of liver biopsy,there were 117 cases of mild liver fibrosis(S0-S1)and 162 cases of significant liver fibrosis(S2-S4).The independent predictors of liver fibrosis were analyzed by multivariate logistic regression analysis and a noninvasive predictive model was constructed.The model for predicting the severity of liver fibrosis was evaluated by receiver operating characteristic curve(ROC).Results Multivariate logistic regression analysis showed that age,prothrombin time(PT),aspartate aminotransferase(AST),anti-HBc and HBV DNA were independent predictors of liver fibrosis(OR=1.055,1.365,1.027,1.231,0.763,all P<0.05).The area under the ROC curve(AUR)of the model was 0.772(95%CI:0.716-0.828,P<0.05),the sensitivity and specificity for the diagnosis of significant liver fibrosis were 79.5%and 70.9%at the cut-off value of 0.504.The AUC of APRI model and FIB-4 index model for assessing significant liver fibrosis in CHB patients with HBeAg-positive and ALT<2×ULN were 0.720 and 0.671,respectively,which were lower than that of the current model(all P<0.05).Conclusion The noninvasive predictive model constructed in this study has a high diagnostic value for evaluating the severity of liver fibrosis in CHB patients with HBeAg positive and ALT<2×ULN.

关 键 词：肝炎 乙型 慢性 肝纤维化 血清学指标 无创预测模型 诊断 

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