ALT轻度异常的慢性乙型肝炎患者肝组织病理特征及血清学无创诊断模型的价值分析  

Value analysis of liver histopathological fcatures and serological noninvasive diagnostic model in chronic hepatitis B patients with mild ALT abnormality

作　　者：赵云[1] 张媛媛 堵妍 吴婷婷[1] ZHAO Yun;ZHANG Yuan-yuan;DU Yan;WU Ting-ting(Department of Clinical Laboratory,the Fourth People′s Hospital of Huai′an(Huaian Jiangsu,223002),China)

机构地区：[1]江苏省淮安市第四人民医院检验科,江苏淮安223002

出　　处：《中西医结合肝病杂志》2024年第6期509-512,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：淮安市科技项目(No.HAB202125)。

摘　　要：目的:分析丙氨酸氨基转移酶(ALT)<2倍正常值上限(ULN)慢性乙型肝炎(CHB)患者的肝脏病理特征,并评估不同血清学诊断模型对肝纤维化的诊断价值。方法:回顾性分析2019年10月至2023年5月于江苏省淮安市第四人民医院就诊的ALT<2ULN,且进行肝穿刺检查的CHB患者62例。收集患者临床资料,根据肝穿结果将S2以下者定为无明显纤维化组(35例),S2及以上者定为明显纤维化组(27例)。对两组患者的临床指标进行分析,采用受试者操作特征曲线(ROC)分析国际标准化比值/血小板比值(INPR)、天门冬氨酸氨基转移酶和血小板比率指数(APRI)、肝纤维化4因子指数(FIB-4)、γ-谷氨酰转肽酶和血小板比值(GPR)、S指数对肝脏病理纤维化的诊断效能。采用Spersman检验分析不同的无创诊断模型与肝组织纤维化之间的关系。结果:62例ALT<2ULN且行肝穿刺的CHB患者中纤维化程度分期为S0期16例(25.8%),S1期19例(30.6%),S2期19例(30.6%),S3期8例(12.9%)。分析62例患者的相关临床指标分层与肝脏纤维化的关系,仅HBsAg水平(以3.0×10^(3)IU/ml为界限分层)差异有统计学意义(χ^(2)=4.07,P=0.044);两组患者的凝血酶原时间(PT),血小板计数(PLT)差异均有统计学意义(P<0.05)。FIB-4(r=0.432,P<0.001)、INPR(r=0.426,P=0.001)、APRI(r=0.388,P=0.02)、S指数(r=0.373,P=0.003)、GPR(r=0.307,P=0.015)均与肝组织纤维化程度正相关。INPR诊断肝脏纤维化(S2以上)的曲线下面积最高,为0.739,灵敏度也最高,为66.7%,而FIB-4特异度最高,为94.3%。结论:ALT<2 ULN的CHB患者发生肝纤维化的比例较高,其中HBsAg<3.0×10^(3)IU/ml,PT延长,PLT降低是其危险因素。5种无创诊断模型对肝纤维化的发生具有一定的预测价值,临床实践中可动态监测这几种模型的变化,为临床初步筛查提供依据。Objective:To analyze the liver pathological features of chronic hepatitis B(CHB)patients with alanine aminotransferase(ALT)<2ULN(2ULN),and to evaluate the diagnostic value of different serological models for liver fibrosis.Methods:A retrospective analysis of 62 CHB patients with ALT<2ULN and liver biopsy was performed in the Fourth People's Hospital of Huai'an City,Jiangsu Province from October 2019 to May 2023.The clinical data of patients were collected,and according to the results of liver tissue biopsy,the patients below S2 were classified as the group without obvious fibrosis(35 cases),and the patients above S2 were classified as the group with obvious fibrosis(27 cases).Two independent sample t test,Mann-Whitney U test andχ2 test were used to analyze the clinical indicators of the two groups.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficacy of international normalized ratio/platelet ratio(INPR),aspartate aminotransferase and platelet ratio index(APRI),liver fibrosis factor 4 index(FIB-4),γ-glutamyl transpeptidase and platelet ratio(GPR),and S index in pathological liver fibrosis.Spersman test was used to analyze the relationship between different noninvasive diagnostic models and hepatic fibrosis.Results:Among 62 CHB patients with ALT<2ULN and liver puncture,the degree of fibrosis was S0 stage 16(25.8%),S1 stage 19(30.6%),S2 stage 19(30.6%),S3 stage 8 cases(12.9%).The correlation between the stratification of relevant clinical indicators and liver fibrosis in 62 patients was analyzed.Only the level of HBsAg(stratified by 3.0×10^(3)IU/ml)was statistically significant(χ^(2)=4.07,P=0.044).Results Analysis showed that there were significant differences in prohemase time(PT)and platelet count(PLT)between the two groups(P<0.05).FIB-4(coefficient of correlation:0.432,P<0.001),INPR(coefficient of correlation:0.426,P=0.001),APRI(coefficient of correlation:0.388,P=0.02),S index(coefficient of correlation:0.373,P=0.003),GPR(coefficient of correlation:0.307,P=0.015)were positiv

关 键 词：慢性乙型肝炎 肝脏病理 纤维化 诊断模型 

分 类 号：R512.6[医药卫生—内科学]