无创炎症诊断模型在非酒精性脂肪性肝病合并乙型肝炎病毒感染患者肝纤维化诊断中的应用  

Application of non-invasive inflammation diagnosis model in the diagnosis of non-alcoholic fatty liver disease and liver fibrosis in patients with combined hepatitis B virus infection

作　　者：吴旭光 马立华 占国祥 黄志刚 Wu Xuguang;Ma Lihua;Zhan Guoxiang;Huang Zhigang(Department of Infection,China Coast Guard Hospital of People′s Armed Police,Jiaxing 314001,China;Orthopedic Center,Xin′an International Hospital Affiliated to Jiaxing University,Jiaxing 314001,China;Department of Internal Medicine,China Coast Guard Hospital of People′s Armed Police,Jiaxing 314001,China;Department of Geriatrics,Ivy League Hospital,Jiaxing 314000,China)

机构地区：[1]中国人民武装警察部队海警总队医院感染科,嘉兴314001 [2]嘉兴学院附属新安国际医院骨科中心,嘉兴314001 [3]中国人民武装警察部队海警总队医院内科,嘉兴314001 [4]常春藤医院老年病科,嘉兴314000

出　　处：《中国医师杂志》2024年第2期245-249,共5页Journal of Chinese Physician

摘　　要：目的分析无创炎症诊断模型在非酒精性脂肪性肝病(NAFLD)合并乙型肝炎病毒(HBV)感染患者肝纤维化诊断中的应用价值。方法选取2019年6月至2021年10月中国人民武装警察部队海警总队医院收治的98例NAFLD合并HBV感染患者,检测其肝硬度值(LSM)、天冬氨酸转氨酶与血小板比率(APRI)、γ-谷氨酰转肽酶与血小板比率(GPR)及基于4因子纤维化指数(FIB-4),利用受试者工作特征(ROC)曲线分析其对NAFLD合并HBV感染肝纤维化临床的诊断效能。结果98例患者中,S0期7例,S1期47例,S2期21例,S3期14例,S4期9例;包括明显肝纤维化35例、肝硬化9例。不同分期组患者性别、BMI比较差异无统计学意义(均P>0.05)。年龄:S0期组<S1期组<S2期组<S3期组<S4期组(P<0.05);LSM、APRI、FIB-4:S0期组<S1期组<S2期组<S3期组<S4期组(均P<0.05);S0期组与S1期组GPR明显小于其余组(P<0.05),且S2期组<S3期组<S4期组(P<0.05)。LSM诊断明显肝纤维化的灵敏度为71.6%、特异度为83.1%;APRI的灵敏度为61.4%、特异度为80.9%;GPR的灵敏度为82.3%、特异度为66.8%;FIB-4的灵敏度为66.2%、特异度为69.5%。LSM诊断肝硬化的灵敏度为86.1%、特异度为67.5%;APRI的灵敏度为77.4%、特异度为75.2%;GPR的灵敏度为79.6%、特异度为75.3%;FIB-4的灵敏度为81.2%、特异度为60.4%。结论NAFLD合并HBV感染患者随着肝纤维化加重,LSM、APRI、GPR、FIB-4呈现明显升高趋势,该类无创炎症诊断模型对肝纤维化均具有一定诊断价值,其中以LSM、GPR的诊断效能较高。Objective To analyze the application value of non-invasive inflammation diagnosis model in the diagnosis of liver fibrosis in patients with non-alcoholic fatty liver disease(NAFLD)combined with hepatitis B virus(HBV)infection.Methods A total of 98 patients with NAFLD complicated with HBV infection admitted to some coastal China Coast Guard Hospital of People′s Armed Police from June 2019 to October 2021 were selected.Their liver stiffness(LSM),aspartate aminotransferase to platelet ratio(APRI),γ-glutamyltranspeptidase to platelet ratio(GPR),and fibrosis index based on factor 4(FIB-4)were measured,The receiver operating characteristic(ROC)curve was used to analyze its clinical diagnostic efficacy for liver fibrosis caused by NAFLD combined with HBV infection.Results Among 98 patients,there were 7 cases in S0 stage,47 cases in S1 stage,21 cases in S2 stage,14 cases in S3 stage,and 9 cases in S4 stage;Including 35 cases of obvious liver fibrosis and 9 cases of cirrhosis.There was no statistically significant difference in gender and body mass index(BMI)among patients in different stages(all P>0.05).Age:the S0 group<the S1 group<the S2 group<the S3 group<the S4 group(P<0.05);LSM,APRI,FIB-4:S0 group<S1 group<S2 group<S3 group<S4 group(all P<0.05);The GPR of the S0 and S1 groups was significantly lower than the other groups(P<0.05),and the S2 group<the S3 group<the S4 group(P<0.05).The sensitivity and specificity of LSM in diagnosing obvious liver fibrosis were 71.6%and 83.1%,respectively;The sensitivity and specificity of APRI were 61.4%and 80.9%,respectively;The sensitivity and specificity of GPR were 82.3%and 66.8%,respectively;The sensitivity and specificity of FIB-4 were 66.2%and 69.5%,respectively.The sensitivity and specificity of LSM in diagnosing liver cirrhosis were 86.1%and 67.5%,respectively;The sensitivity and specificity of APRI were 77.4%and 75.2%,respectively;The sensitivity and specificity of GPR were 79.6%and 75.3%,respectively;The sensitivity and specificity of FIB-4 were 81.2%and 60.4%,respective

关 键 词：非酒精性脂肪性肝病 乙型肝炎 肝纤维化 炎症诊断模型 

分 类 号：R575.5[医药卫生—消化系统] R512.62[医药卫生—内科学]