无创方法诊断HBeAg阳性慢性乙型肝炎患者肝内炎症反应程度  

Diagnostic Vslue of Noninvasive method to Predict Liver Inflammation in HBeAg-Positive Hepatitis B Patients

作　　者：叶雅妹 周丽娜 杨文彦 孙芳 林勇 林春 潘晨 YE Yamei;ZHOU Lina;YANG Wenyan;SUN Fang;LIN Yong;LIN Chun;PAN Chen(Department of Metabolic Hepatology,Mengchao Hepatobiliary Hospital,Fujian Medical University,Fuzhou,Fujian 350000,China)

机构地区：[1]福建医科大学孟超肝胆医院代谢性肝病科,福建福州350000

出　　处：《检验医学与临床》2024年第2期237-241,246,共6页Laboratory Medicine and Clinic

摘　　要：目的建立由简单常规实验数据组成的模型,以预测HBeAg阳性且丙氨酸氨基转移酶(ALT)≤2倍正常上限的慢性乙型肝炎(CHB)患者的肝脏炎症反应程度。方法选取2019年4月1日至2021年5月8日151例HBeAg阳性且ALT≤2倍正常上限的CHB患者作为研究对象,根据肝脏病理检查结果分为轻度炎症反应[肝组织炎症分级(G)G0~1]组和中度炎症反应(G≥2)组,采用多因素Logistic回归分析CHB患者发生中度炎症反应的独立危险因素并建立诊断模型。结果53.0%(80/151例)的研究对象出现G≥2。G≥2组ALT、天门冬氨酸氨基转移酶(AST)水平均明显高于G0~1组,胆碱酯酶(ChE)、前蛋白比(PA)、HBsAg均明显低于G0~1组,差异均有统计学意义(P<0.05)。ALT、AST与G分级均呈弱正相关(r=0.212、0.303,P<0.05),ChE、PA、HBsAg与G分级均呈弱负相关(r=-0.371、-0.330、-0.173,P<0.05)。高水平AST、低水平PA、低水平logChE为CHB患者发生中度炎症反应的独立危险因素(P<0.05)。模型CPA对预测发生G≥2的受试者工作特征曲线下面积为0.842(95%CI:0.741~0.935)。当CPA≤0.3,其排除G≥2的阴性预测值为84.21%;当CPA≥0.6时,CPA诊断发生G≥2的阳性预测值为84.00%。结论AST、PA和logChE与HBsAg阳性且ALT≤2倍正常上限的CHB患者的肝内炎症反应程度相关。CPA对发生G≥2具有较好的诊断效能,且该模型涉及的指标简单易得,适合临床推广使用。Objective To establish a model composed of simple routine experimental data to predict the degree of liver inflammation response in chronic hepatitis B(CHB)patients with HBeAg positive and alanine aminotransferase(ALT)≤2 times the upper limit of normal.Methods A total of 151 CHB patients with HBeAg postive and ALT≤2 times the upper limit of normal from April 1,2019 to May 8,2021 were selected as the research objects.According to the results of liver pathological examination,they were divided into mild inflammation response[liver tissue inflammation grade(G)0-1]group and moderate inflammation response(G≥2)group.Multivariate Logistic regression was used to analyze the independent risk factors of moderate inflammation in CHB patients and establish a diagnostic model.Results The research object of 53.0%(80/151 cases)appeared G≥2.The levels of ALT and AST in G≥2 group were significantly higher than those in G0-1 group(P<0.05).The levels of ChE,PA and HBsAg in G≥2 group were significantly lower than those in G0-1 group(P<0.05).The levels ALT and AST were weakly positively correlated with G grade(r=0.212,0.303,P<0.05),ChE,PA,HBsAg were negatively and weakly correlated with G grade(r=-0.371,-0.330,-0.173,P<0.05).High level of AST,low level of PA and low level of logChE were independent risk factors for moderate inflammation response in CHB patients(P<0.05).The area under the receiver operating characteristic curve of model CPA for predicting the occurrence of G≥2 was 0.842(95%CI:0.741-0.935).When CPA≤0.3,the negative predictive value of excluding G≥2 was 84.21%.When CPA≥0.6,the positive predictive value of CPA for G≥2 was 84.00%.Conclusion AST,PA and logChE are associated with the degree of intrahepatic inflammation response in CHB patients with HBsAg positive and ALT≤2 times upper limit of normal.CPA has a good diagnostic efficacy for the occurrence of G≥2,and the indicators involved in the model are simple and easy to obtain,which is suitable for clinical application.

关 键 词：慢性乙型肝炎 乙型肝炎E抗原 肝穿刺 炎症反应 无创模型 

分 类 号：R512.62[医药卫生—内科学]