丙氨酸转氨酶正常的乙型肝炎e抗原阴性慢性乙型肝炎患者的肝脏病理特征及血清学无创诊断模型价值分析  

Liver pathological characteristics and the value of serum non-invasive diagnostic model in chronic hepatitis B patients with normal alanine aminotransferase and negative hepatitis B e antigen

作　　者：宁会彬 靳慧鸣 李宽 彭真 尚佳 Ning Huibin;Jin Huiming;Li Kuan;Peng Zhen;Shang Jia(Department of Infectious Diseases,Henan Provincal People′s Hospital(Zhengzhou University People′s Hospital),Zhengzhou 450000,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)感染科,郑州450000

出　　处：《中华传染病杂志》2022年第12期729-734,共6页Chinese Journal of Infectious Diseases

摘　　要：目的分析丙氨酸转氨酶(alanine aminotransferase,ALT)正常的乙型肝炎e抗原(hepatitis B e antigen,HBeAg)阴性慢性乙型肝炎(chronic hepatitis B,CHB)患者的肝脏病理特征,并评估不同肝纤维化血清学诊断模型的价值。方法回顾性分析2016年8月至2019年12月于河南省人民医院感染科就诊的ALT正常且进行肝穿刺活组织检查的HBeAg阴性CHB患者。收集患者临床资料、血清乙型肝炎病毒(hepatitis B virus,HBV)指标和HBV DNA,并通过病理检查评估肝纤维化分期(S)。采用受试者操作特征曲线分析γ-谷氨酰转肽酶和血小板比值(gamma-glutamyl transpeptidase to platelet ratio,GPR)、肝纤维化4因子指数(fibrosis 4 score,FIB-4)、S指数、天冬氨酸转氨酶和血小板比率指数(aspartate aminotransferase to platelet ratio index,APRI)和γ-谷氨酰转肽酶与白蛋白比值(gamma-glutamyl transpeptidase to albumin ratio,γ-GT/ALB)对肝脏病理纤维化的诊断效能。采用两变量相关性检验分析不同无创诊断模型与肝组织病理纤维化之间的关系。统计学比较采用χ^(2)检验。结果448例患者的年龄为(37.98±9.82)岁,男女比为1.286∶1。年龄>30岁、乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)<2000 IU/mL和HBV DNA≥2000 IU/mL的患者中S≥2者所占比例分别高于年龄≤30岁、HBsAg≥2000 IU/mL和HBV DNA<2000 IU/mL的患者,差异均有统计学意义(χ^(2)=7.68,P=0.006;χ^(2)=11.44,P=0.001;χ^(2)=9.12,P=0.003)。肝病理纤维化分期S<2者250例,S=2者162例,S≥3者36例。FIB-4(相关系数为0.250)、APRI(相关系数为0.218)、GPR(相关系数为0.186)、S指数(相关系数为0.184)和γ-GT/ALB(相关系数为0.127)与肝脏病理纤维化程度均呈正相关(均P<0.050)。S指数诊断显著肝纤维化(S≥2)的灵敏度最高,为64.1%,而γ-GT/ALB的特异度最高,为80.8%。γ-GT/ALB诊断重度肝纤维化(S≥3)的灵敏度最高,为77.8%,而APRI的特异度最高,为78.6%。结论ALT正常的HBeAg阴性CHB患者肝纤Objective To analyze the liver pathological characteristics of chronic hepatitis B(CHB)patients with normal alanine aminotransferase(ALT)and negative hepatitis B e antigen(HBeAg),and to evaluate the diagnostic value of different serological models for liver fibrosis.Methods Retrospective analysis was conducted on the patients with HBeAg-negative CHB who had normal ALT and underwent liver biopsy from August 2016 to December 2019 in the Department of Infectious Diseases,Henan Provincial People′s Hospital.The clinical data,serum indicators of hepatitis B virus(HBV)and HBV DNA were collected.The liver fibrosis stages(S)was assessed by pathological examination.The diagnostic efficacies of gamma-glutamyl transpeptidase to platelet ratio(GPR),fibrosis 4 score(FIB-4),S index,aspartate aminotransferase to platelet ratio index(APRI)and gamma-glutamyl transpeptidase to albumin ratio(γ-GT/ALB)for liver pathological fibrosis were analyzed by the receiver operating characteristic curves.Two variable correlation test was used to explore the relationship between the different models and pathological fibrosis of liver tissue.Chi-square test was used for statistical comparison.Results The age of 448 patients was(37.98±9.82)years,and the male to female ratio was 1.286∶1.The proportions of S≥2 in patients with age>30 years,hepatitis B surface antigen(HBsAg)<2000 IU/mL and HBV DNA≥2000 IU/mL were higher than those in patients with age≤30 years,HBsAg≥2000 IU/mL and HBV DNA<2000 IU/mL,respectively,and the differences were all statistically significant(χ^(2)=7.68,P=0.006;χ^(2)=11.44,P=0.001;χ^(2)=9.12,P=0.003,respectively).There were 250 cases with pathological fibrosis stage S<2,162 cases with S=2 and 36 cases with S≥3.FIB-4(correlation coefficient 0.250),APRI(correlation coefficient 0.218),GPR(correlation coefficient 0.186),S index(correlation coefficient 0.184)andγ-GT/ALB(correlation coefficient 0.127)were positively correlated with the severity of liver fibrosis(all P<0.050).S index had the highest sensitivity(64

关 键 词：乙型肝炎 慢性 肝脏病理 纤维化 诊断模型 

分 类 号：R512.62[医药卫生—内科学]