谷丙转氨酶持续正常HBeAg阳性慢性HBV感染者肝组织学病变的独立危险因素探讨及无创模型建立  

Independent Risk:Factors and Noninvasive Model Establishment of Liver Histological Changes in HBeAg-Positive Chronic HBV Infection Patients with Normal Alanine Aminotransferase

作　　者：刘勇 邹亚文 孙嬴 王雪梅[1] 余祖江[1] LIU Yong;ZOU Yawen;SUN Ying;WANG Xuemei;YU Zujiang(Department of Infectious Diseases,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院感染科,河南郑州450000

出　　处：《河南医学研究》2022年第3期403-409,共7页Henan Medical Research

摘　　要：目的探讨谷丙转氨酶(ALT)持续正常HBeAg阳性慢性乙型肝炎病毒(HBV)感染者肝组织学发生显著病变的独立危险因素,并进一步构建预测肝组织学病变的无创模型。方法回顾性纳入2016年5月至2020年11月在郑州大学第一附属医院就诊的ALT持续正常HBeAg阳性慢性HBV感染者251例。所有入选患者均未曾接受抗病毒治疗,并根据入院时间分为训练队列(n=156)和验证队列(n=95)。根据肝组织病理活检结果,将入组患者分为显著肝组织病变组[炎症活动度≥G_(2)和(或)纤维化程度≥S_(2)]和非显著肝组织病变组(炎症活动度<G_(2)且纤维化程度<S_(2))。在训练队列中使用logistic回归模型筛选ALT持续正常HBeAg阳性慢性HBV感染者发生肝组织学病变的独立危险因素,应用受试者工作特征(ROC)曲线下面积(AUC)评估无创模型的预测效能。结果训练队列和验证队列分别有55例(35.3%)和33例(34.7%)患者存在显著肝组织病变。多因素分析表明,年龄(P=0.016)、HBsAg定量(P=0.002)和肝硬度测定(LSM)(P<0.001)是ALT持续正常HBeAg阳性慢性HBV感染者肝组织学发生显著病变的独立危险因素。由年龄、HBsAg定量和LSM构成的新型无创模型,在训练队列预测肝组织病变的AUC为0.861,优于谷草转氨酶与血小板比率指数(APRI)(AUC=0.759,P=0.011)、基于4因子的纤维化指数(FIB-4)(AUC=0.766,P=0.012)和LSM(AUC=0.808,P=0.042);在验证队列预测效能为0.872,仍优于APRI(AUC=0.765,P=0.029)、FIB-4(AUC=0.782,P=0.035)和LSM(AUC=0.798,P=0.045)。结论年龄、HBsAg定量和LSM是ALT持续正常HBeAg阳性慢性HBV感染者肝组织学发生显著病变的独立危险因素;由这3个参数构建的新型无创模型预测肝组织病变的效能优于APRI、FIB-4和LSM。Objective To investigate the independent risk factors for significant liver histological chronic hepatitis B virus(HBV)infection patients with normal alanine aminotransferase(ALT),then to develop noninvasive model for predicting liver histology.Metliods A total of 251 patients with chronic HBV infection who were treated in the First Affiliated Hospital of Zhengzhou University from May 2016 to November 2020 were retrospectively enrolled.All patients were treatment-naive and divided into training cohort(n=156)and validation cohort(n=95)according to time of admission.According to the results of liver biopsies,the enrolled patients were divided into two groups:(inflammation activity ≥G_(2) and/or degree of fibrosis≥S_(2))and no significant liver lesion group(inflammation activity<G_(2) and degree of fibrosis<S_(2)).Logistic regression was used to explore the independent risk factors for liver histological changes in the training cohort.The area under receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive performance of the noninvasive model.Results Fifty-five patients(35.3%)in the training cohort and 33 patients(34.7%)in the validation cohort,and they had significant liver lesions respectively.Multivariate analysis showed that age(P=0.016),HBsAg(P=0.002)and liver stiffness measurement(LSM)(P<0.001)were independent risk factors for significant liver histological changes.Consequently,a new noninvasive model,which was composed of age,HBsAg and LSM,was developed predict the presence of liver histology.The AUC of the new noninvasive model was 0.861 in the than that of aspartate aminotransferase to platelet ratio index(APRI)(AUC=0.779,P=0.011),fibrosis 4 score(FIB-4)(AUC=0.766,P=0.012)and LSM(AUC=0.808,P=0.042).In the validation cohort,the predictive performance of the noninvasive model was 0.872,which was also better than that of APRI(AUC=0.765,P=0.029),FIEi-4(AUC=0.782,P=0.035)and LSM(AUC=0.798,P=0.045).Conclusion Age,HBsAg and LSM are independent risk factors for liver histological chang

关 键 词：慢性乙型肝炎 HBEAG阳性 肝组织病变 无创模型 

分 类 号：R575.1[医药卫生—消化系统]