GPR参数模型联合Fibroscan对慢性乙型肝炎肝纤维化的诊断效能  

Clinical value of GPR parameter model combined with Fibroscan for evaluating the stage of liver fibrosis in patientes with chronic hepatitis B

作　　者：张鑫[1] 朱桂娟 叶晓航[1] 张荣荣[1] 张睿[2] 朱礼尧[2] 姚梦础 ZHANG Xin;ZHU Gui-juan;YE Xiao-hang;ZHANG Rong-rong;ZHANG Rui;ZHU Li-yao;YAO Meng-chu(Department of Imaging,Huaian Fourth People′s Hospital,Jiangsu 223000,China;Department of Hepatology,Huaian Fourth People′s Hospital,Jiangsu 223000,China;Huaian First People’s Hospital,Jiangsu 223000,China)

机构地区：[1]淮安市第四人民医院影像科,江苏223000 [2]淮安市第四人民医院肝病科,江苏223000 [3]淮安市第一人民医院

出　　处：《肝脏》2022年第8期877-880,共4页Chinese Hepatology

基　　金：2020年江苏省高层次卫生人才“六个一工程”拔尖人才项目(LGY2020059);中国公共卫生联盟(第一批)课题项目(GWLM202016)。

摘　　要：目的 评估GPR参数模型联合Fibroscan对慢性乙型肝炎(CHB)肝纤维化中的的诊断效能。方法 选择2015年1月至2020年12月淮安市第四人民医院收治的患者161例。穿刺前1周内检测Fibroscan(LSM值)以及γ-谷氨酰转肽酶(GGT)、血小板(PLT)计数,并计算GGT/PLT比值(GPR)指数。分析GPR、LSM值与肝纤维化程度的相关性;分析GPR参数模型联合Fibroscan对CHB肝纤维化诊断的准确性。结果 CHB患者F0-F4期LSM值分别为(5.06±1.48)、(5.65±1.48)、(6.29±1.14)、(8.65±2.75)、(14.03±4.24)kPa,差异有统计学意义(F=64.327,P<0.01);与病理肝纤维化分期呈正相关(r=0.730,P<0.01)。F0-F4期GPR值分别为0.32±0.22、0.46±0.40、0.57±0.50、0.80±0.72、1.20±1.06,差异有统计学意义(F=4.921,P<0.01),与病理肝纤维化分期呈正相关(r=0.384,P<0.05)。当以F≥2为分割点进行分组,单独LSM、GPR值和LSM+GPR联合的ROC曲线下面积分别为0.851、0.711、0.862;F≥3时,单独LSM、GPR值和LSM+GPR联合的ROC曲线下面积分别为0.899、0.722、0.911;F=4时,单独LSM、GPR值和LSM+GPR联合的ROC曲线下面积分别为0.921、0.711、0.926。结论 LSM+GPR联合诊断肝纤维化的能力均高于单独的LSM、GPR值,GPR参数模型联合Fibroscan可提高慢性乙型肝炎肝纤维化诊断效能。Objective To investigate the clinical value of GPR parameter model combined with FibroScan for evaluating the stage of liver fibrosis in patients with chronic hepatitis B(CHB).Methods A total of 161 patients with CHB who underwent liver biopsy in our hospital were selected.The clinical date liver stiffness measurement(LSM),gamma-glutamyl transpeptidase(GGT),platelet(PLT)and GPR at 1 week before puncture were collected.To analyze the correlation between GPR,LSM and the degree of liver fibrosis;to analyze the accuracy of GPR parameter model combined with FibroScan in the diagnosis of liver fibrosis in CHB patients.Results The liver LSM values of CHB patients with degree of fibrosis from F0 to F4 were 5.06±1.48,5.65±1.48,6.29±1.14,8.65±2.75 and 14.03±4.24KPa,respectively;and the differences were statistically significant(F=64.327,P<0.001).The LSM value was positively correlated with the stage of pathology(r=0.730,P<0.001).The GPR values of CHB patients with degree of fibrosis from F0 to F4 were 0.32±0.22,0.46±0.40,0.57±0.50,0.80±0.72 and 1.20±1.06,respectively;and the differences were statistically significant(F=4.921,P<0.001).The GPR value was also positively correlated with pathological staging(r=0.384,P<0.05).The area under the curve(AUC)values of LSM,GPR,and LSM combined with GPR for the diagnosis of F≥2 were 0.851,0.711,and 0.862,respectively.The AUC values of LSM,GPR,and LSM combined with GPR for the diagnosis of F≥3 were 0.899,0.722 and 0.911,respectively.The AUC values of LSM,GPR,and LSM combined with GPR for the diagnosis of F=4 were 0.921,0.711 and 0.926,respectively.Conclusion The predictive value of LSM combined with GPR in the diagnosis for liver fibrosis is better than that of LSM or GPR alone.GPR parameter model combined with Fibroscan can be used as a more accurate non-invasive diagnosis model for liver fibrosis,which is worthy of clinical application.

关 键 词：乙型肝炎 肝纤维化 瞬时弹性记录仪 参数模型 

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