免疫耐受期慢性乙型肝炎病毒感染者显著肝组织损伤的新型诊断模型建立  

Establishment of a new diagnostic model for significant liver tissue damage in patients with chronic hepatitis B virus infection in the immune tolerance phase

作　　者：汪东辉 蒋素文 胡爱荣 石小军 朱德东 何哲耘 朱陈倩 张露侃 Wang Donghui;Jiang Suwen;Hu Airong;Shi Xiaojun;Zhu Dedong;He Zheyun;Zhu Chenqian;Zhang Lukan(Ningbo Institute of Liver Diseases,Hwa Mei Hospital,University of Chinese Academy of Sciences(Ningbo No.2 Hospital),Ningbo 315010,China;Graduate School,Medical School of Ningbo University,Ningbo 315211,China)

机构地区：[1]中国科学院大学宁波华美医院(宁波市第二医院)宁波市肝病研究所,宁波315010 [2]宁波大学医学院研究生院,宁波315211

出　　处：《中华传染病杂志》2022年第5期275-280,共6页Chinese Journal of Infectious Diseases

基　　金：浙江省基础公益研究计划项目(LGF22H030002);浙江省医药卫生科技计划项目(2020KY835);宁波市科技服务业示范项目(2019F1039)。

摘　　要：目的建立和评估一种新的判断免疫耐受期慢性乙型肝炎病毒(hepatitis B virus, HBV)感染者显著肝组织损伤的诊断模型。方法收集2015年1月至2020年11月中国科学院大学宁波华美医院275例接受肝脏穿刺活组织检查术的免疫耐受期慢性HBV感染者的临床资料,根据肝组织病理学改变分为<G2组和≥G2组、<S2组和≥S2组、无显著病理损伤组(GS0组,即<G2+<S2)和显著病理损伤组[GS1组,即≥G2和(或)≥S2]。分析其肝脏病理学改变和临床特征,构建显著肝组织损伤的诊断模型,并比较其判断价值。统计学分析采用线性回归分析,应用受试者操作特征曲线下面积、灵敏度、特异度等评估模型的诊断价值。结果275例患者中,肝组织损伤≥G2、≥S2和GS1者分别为43例(15.64%)、30例(10.91%)和55例(20.00%)。与肝组织损伤相关的独立影响因素有年龄、乙型肝炎e抗原、γ-谷氨酰转肽酶、血小板计数、碱性磷酸酶和丙氨酸转氨酶水平(均P<0.050),建立诊断模型YG/S。YG/S在≥G2组、GS1组的诊断效能最高(曲线下面积为0.783、0.811)。YG/S的诊断临界值为0.18,其灵敏度、特异度分别为0.782、0.736,阴性预测值为93.10%。当YG/S<0.05时,其灵敏度、阴性预测值、阴性似然比分别为0.982、97.96%、0.08;当YG/S≥0.25时,其特异度、阳性似然比分别为0.905、5.14;当YG/S≥0.30时,其特异度、阳性似然比分别为0.959、9.33。结论约20.00%的免疫耐受期慢性HBV感染者存在显著肝组织损伤,诊断模型YG/S(<0.05或≥0.30)对该类人群的显著肝组织损伤有一定的诊断价值,在一定程度上可避免肝脏穿刺活组织检查。ObjectiveTo establish and evaluate a new diagnostic model for significant liver tissue damage in patients with chronic hepatitis B virus (HBV) infection in the immune tolerance phase.MethodsThe clinical data of 275 chronic HBV infection patients in the immune tolerance phase who underwent liver biopsy from January 2015 to November 2020 in the Hwa Mei Hospital, University of Chinese Academy of Sciences were included. According to the liver pathological changes, patients were divided into <G2 group and ≥G2 group, <S2 group and ≥S2 group, non-significant liver pathological damage group (GS0 group, <G2+ <S2) and significant liver pathological damage group (GS1 group, G2 and/or ≥S2). The liver pathological changes and clinical features were analyzed to establish the diagnostic model. The prediction value of the model was compared. Statistical analysis was conducted by linear regression analysis, and the area under the receiver operating characteristic curve, sensitivity and specificity for the diagnostic value of the model were calculated.ResultsAmong 275 patients, 43 cases (15.64%) had liver histologic activity ≥G2, 30 cases (10.91%) with liver fibrosis ≥S2, and 55 cases (20.00%) with liver damage of GS1. The correlated independent risk factors associated with significant liver pathological damage were age, levels of hepatitis B e antigen, γ-glutamyl transpeptidase, platelet count, alkaline phosphatase and alanine aminotransferase (all P<0.050). The diagnostic model of YG/S was established according to these factors. The diagnostic efficacy of YG/Swas highest for patients with liver histologic activity≥G2 and liver pathological damage GS1, with the areas under the curve of 0.783 and 0.811, respectively. The threshold of YG/S was 0.18, with the sensitivity, specificity and negative predictive value of 0.782, 0.736 and 93.10%, respectively. When YG/S <0.05, the sensitivity, negative predictive value and negative likelihood ratio were 0.982, 97.96% and 0.08, respectively. When YG/S≥0.25, the specificity a

关 键 词：肝炎 乙型 慢性 病理学 肝 活组织检查 针吸 免疫耐受期 诊断试验评价 

分 类 号：R512.62[医药卫生—内科学] R446.6[医药卫生—临床医学]