慢性乙型肝炎合并非酒精性脂肪性肝病患者无创肝纤维化模型的诊断评价及新模型的建立  

Diagnostic evaluation of non-invasive liver fibrosis models and establishment of a new model in chronic hepatitis B patients complicated with nonalcoholic fatty liver disease

作　　者：高颖惠 邓明月 朱瑞瑞 郭智贤[1] 闫婧雅[1] 赵雪萌 李志勤[1] Gao Yinghui;Deng Mingyue;Zhu Ruirui;Guo Zhixian;Yan Jingya;Zhao Xuemeng;Li Zhiqin(Department of Infectious Disease,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院感染科,郑州450052

出　　处：《中华消化杂志》2024年第10期686-692,共7页Chinese Journal of Digestion

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202102085)。

摘　　要：目的在慢性乙型肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)患者中评估FibroScan与各种诊断模型联合对肝纤维化的诊断效能,并利用临床常用指标建立预测新模型。方法回顾性分析2016年1月至2024年5月于郑州大学第一附属医院接受肝穿刺活体组织检查术(以下简称肝活检)和FibroScan检查的118例CHB合并NAFLD患者的临床资料。根据Scheuer评分系统肝纤维化程度分期设定不同判别终点(S0~S1、≥S2、≥S3和S4期),以纤维化程度分期≥S2期作为显著性肝纤维化的判别标准。根据临床常用指标分别计算肝纤维化指数4(FIB-4)、γ-谷氨酰转移酶(GGT)与血小板比值(GPR)、γ-谷氨酰转移酶-年龄-血小板-国际标准化比值(GAPI)模型、S指数、King指数、Forns指数。两组间比较采用独立样本t检验或Mann-WhitneyU检验,Spearman秩相关用于分析各无创诊断方法与肝纤维化分期的相关性。绘制受试者操作特征曲线(ROC),采用DeLong检验比较曲线下面积(AUC),评价FibroScan与各种诊断模型联合诊断肝纤维化的预测价值。比较非显著性肝纤维化及显著性肝纤维化两组患者的实验室检查指标,并对单因素分析中差异有统计学意义(P<0.05)的指标进一步行多因素logistic回归分析,建立肝纤维化的预测新模型,采用Hosmer-Lemeshow检验评估模型拟合效果。结果Spearman秩相关分析结果显示,肝纤维化分期分别与FIB-4、GPR、FibroScan、GAPI模型、S指数、King指数、Forns指数呈正相关(r=0.413、0.458、0.512、0.473、0.533、0.380、0.478,均P<0.001)。ROC分析结果显示,在FibroScan与其他诊断模型组合中FibroScan+FIB-4、FibroScan+Forns指数诊断肝纤维化程度分期≥S2和≥S3期的AUC较高,分别为0.804、0.907。非显著性肝纤维化组患者血小板计数[(200.65±50.89)×10^(9)/L比(169.96±63.68)×10^(9)/L]、总胆固醇[(4.69±0.77)mmol/L比(4.32±1.00)mmol/L]、高密度脂蛋白[1.28(1.05,1.46)mmol/L比1.08(0.92,1.Objective To evaluate the diagnostic efficacy of FibroScan combined with various noninvasive diagnostic models for liver fibrosis in patients with chronic hepatitis B(CHB)complicated with nonalcoholic fatty liver disease(NAFLD),and to establish a new predictive model with common clinical indicators.Methods From January 2016 to May 2024,the clinical data of 118 CHB patients complicated with NAFLD from the First Affiliated Hospital of Zhengzhou University,who underwent liver biopsy and FibroScan examination were respectively analyzed.According to the Scheuer scoring system,different diagnostic endpoints were set based on the degree of liver fibrosis(SO to S1,≥S2,≥S3,and S4),fibrosis stage≥S2 was designated as the criterion for significant liver fibrosis.Fibrosis-4(FIB4),-glutamyl transpeptidase(CCT)to platelet ratio(GPR),GGT-age-platelet-international normalized ratio(GAPI)model,S index,King index and Forns index were calculated according to the common clinical indicators.The independent t test or Mann-Whitney U test was used to compare the two groups.Spearman rank correlation was used to analyze the correlation between each noninvasive diagnostic method and the degree of liver fibrosis.Receiver operating characteristic curve(ROC)was plotted,and the DeLong test was performed to compare the area under the curve(AUC),and to evaluate the predictive value of FibroScan combined with various noninvasive diagnostic models for the diagnosis of liver fibrosis.The laboratory indicators were compared between patients with non-significant liver fibrosis and patients with significant liver fibrosis.And the indicators with statistically significant differences(P<0.05)in the univariate analysis were further analyzed by multivariate logistic regression to establish a new predictive model for liver fibrosis.Hosmer-Lemeshow test was used to assess the model's goodness of fit.Results The results of Spearman rank correlation showed that FIB4,GPR,FibroScan,GAPI model,S index,King index,and Forns index were positively correlated w

关 键 词：慢性乙型病毒性肝炎 非酒精性脂肪肝 肝纤维化 无创诊断模型 

分 类 号：R57[医药卫生—消化系统]