六种常用血清学诊断模型对成人乙型肝炎e抗原阳性患者肝纤维化的诊断价值比较  

Diagnostic value comparison of six commonly used serological diagnostic models for liver fibrosis in adult hepatitis B e-antigen positive patients

作　　者：孟鹏[1] 高丽[1] 王晓蕾 李静[1] 张云 张瀚文 王林萍[1] MENG Peng;GAO Li;WANG Xiaolei;LI Jing;ZHANG Yun;ZHANG Hanwen;WANG Linping(Department of Outpatient,Zibo Central Hospital,Shandong Province,Zibo255036,China;Department of Outpatient,Sixth Medical Center of Chinese PLA General Hospital,Beijing100048,China;Department of Gastroenterology,First Medical Center of Chinese PLA General Hospital,Beijing100080,China)

机构地区：[1]山东省淄博市中心医院门诊部,山东淄博255036 [2]中国人民解放军总医院第六医学中心门诊部,北京100048 [3]中国人民解放军总医院第一医学中心消化内科,北京100080

出　　处：《中国医药导报》2024年第16期1-4,共4页China Medical Herald

基　　金：山东省自然科学基金面上项目(ZR2022MH053)。

摘　　要：目的比较六种常用血清学诊断模型对成人乙型肝炎e抗原阳性患者肝纤维化的诊断价值。方法选取山东省淄博市中心医院和中国人民解放军总医院第六医学中心2018年1月至2023年6月诊断为慢性乙型肝炎并行肝病理组织活检的265例患者为研究对象。采集临床常用的球蛋白与血小板比值(GPR)、纤维化4因子指数(FIB-4)、天冬氨酸转氨酶-血小板比率指数(APRI)、天冬氨酸转氨酶与丙氨酸转氨酶比值(AAR)、纤维化硬化指数(FCI)、S指数(S-index)六种血清学诊断模型的相关指标,以肝组织穿刺活检结果为“金标准”,应用受试者操作特征曲线评估六种模型的诊断效能。结果F1~F4期年龄、血小板计数、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶、白蛋白、APRI、FIB-4、GPR、S-index和FCI比较,差异有统计学意义(P<0.05)。区分F_(1)~F_(4)时,GPR、APRI、FIB-4、FCI和S-index模型的曲线下面积均>0.70,AAR模型曲线下面积的95%CI为0.50。区分F_(1)与F_(2)~F_(4)、F_(1)~F_(2)与F_(3)~F_(4)、F_(1)~F_(3)与F_(4)时,GPR、APRI、FIB-4、FCI和S-index模型的曲线下面积均大于AAR模型(P<0.05)。结论FIB-4、GPR、S-index和FCI均能较好地区分乙型肝炎e抗原阳性慢性乙型肝炎患者肝纤维化的严重程度,APRI区分效能则按F_(1)~F_(4)的顺序呈逐渐降低趋势,AAR基本不能对肝纤维化的严重程度作出判断。Objective To compare diagnostic value of six commonly used serological diagnostic models for liver fibrosis in adult hepatitis B e-antigen positive patients.Methods Two hundred and sixty-five patients diagnosed with chronic hepatitis B and underwent liver pathological tissue biopsy from January 2018 to June 2023 at Zibo Central Hospital of Shandong Province and Sixth Medical Center of Chinese PLA General Hospital were selected as research subjects.Relevant indicators of six commonly used clinical serological diagnostic models including gamma-glutamyltranspeptidase to platelet ratio(GPR),fibrosis 4 factor index(FIB-4),aspartate aminotransferase to platelet ratio index(APRI),aspartate to alanine aminotransferase ratio(AAR),fibrosis cirrhosis index(FCI),and S-index were collected.Liver tissue biopsy results as“gold standard”the curve of receiver operating characteristic was used to evaluate diagnostic performance of six models.Results There were significant differences in age,platelet count,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,gamma-glutamyl transpeptidase,albumin,APRI,FIB-4,GPR,S-index,and FCI among stages F_(1)-F_(4)(P<0.05).When distinguishing F_(1)-F_(4),areas under the curves of GPR,APRI,FIB-4,FCI,and S-index models were all greater than 0.70,and 95%CI of area under the curve of AAR model included 0.50.When distinguishing between F_(1) and F_(2)-F_(4),F_(1)-F_(2)and F_(3)-F_(4),F_(1)-F_(3)and F_(4),area under the curves of GPR,APRI,FIB-4,FCI and S-index models were greater than those of AAR model(P<0.05).Conclusion FIB-4,GPR,S-index,and FCI can effectively distinguish severity of liver fibrosis in chronic hepatitis B patients with positive hepatitis B e-antigen.Discriminative power of APRI gradually decreases in order of F_(1)to F_(4),and AAR is basically unable to judge severity of liver fibrosis.

关 键 词：诊断模型 乙型肝炎e抗原阳性 肝纤维化 慢性乙型肝炎 

分 类 号：R512.62[医药卫生—内科学]