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常见临床指标及无创肝纤维化评分对中国肝病型Wilson病进展期肝纤维化的诊断价值

梁晨 刘晖 白洁 任艳 王泰龄 刘念晨 白丽 刘霜 陈煜 段钟平 郑素军

梁晨, 刘晖, 白洁, 等. 常见临床指标及无创肝纤维化评分对中国肝病型Wilson病进展期肝纤维化的诊断价值[J]. 临床肝胆病杂志, 2021, 37(3): 570-574. DOI: 10.3969/j.issn.1001-5256.2021.03.014
引用本文: 梁晨, 刘晖, 白洁, 等. 常见临床指标及无创肝纤维化评分对中国肝病型Wilson病进展期肝纤维化的诊断价值[J]. 临床肝胆病杂志, 2021, 37(3): 570-574. DOI: 10.3969/j.issn.1001-5256.2021.03.014
LIANG C, LIU H, BAI J, et al. Value of common clinical indices and noninvasive liver fibrosis scores in the diagnosis of advanced liver fibrosis in hepatic-type Wilson's disease in China[J]. J Clin Hepatol, 2021, 37(3): 570-574. DOI: 10.3969/j.issn.1001-5256.2021.03.014
Citation: LIANG C, LIU H, BAI J, et al. Value of common clinical indices and noninvasive liver fibrosis scores in the diagnosis of advanced liver fibrosis in hepatic-type Wilson's disease in China[J]. J Clin Hepatol, 2021, 37(3): 570-574. DOI: 10.3969/j.issn.1001-5256.2021.03.014

常见临床指标及无创肝纤维化评分对中国肝病型Wilson病进展期肝纤维化的诊断价值

DOI: 10.3969/j.issn.1001-5256.2021.03.014
基金项目: 

北京市医院管理局消化内科学科协同发展中心项目 XXZ0503

科技创新服务能力建设-高精尖学科建设项目 11920703

详细信息
    作者简介:

    梁晨(1996—),女,主要从事遗传代谢性肝病研究

    通讯作者:

    郑素军,zhengsujun003@126.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:梁晨负责资料查阅、写作;刘晖、郑素军负责写作框架设计;梁晨、刘晖、白洁、王泰龄参与数据收集、分析;任艳、刘念晨、白丽负责数据分析;刘霜、陈煜、段钟平、郑素军负责审核结果。
  • 中图分类号: R575.2;R589.9

Value of common clinical indices and noninvasive liver fibrosis scores in the diagnosis of advanced liver fibrosis in hepatic-type Wilson's disease in China

  • 摘要:   目的  探讨常见临床指标及无创肝纤维化评分与中国肝病型Wilson病(WD)的关系,及其对进展期肝纤维化的鉴别能力。  方法  回顾性收集1996年5月—2020年4月于北京佑安医院及中日友好医院诊治的236例中国WD患者临床资料,纳入有肝脏病理且临床资料齐全的肝病型WD患者26例,应用METAVIR评分判断肝纤维化分期,将患者分为进展期肝纤维化(F3期、F4期)和非进展期肝纤维化(F0期、F1期、F2期)两组,计算3种无创肝纤维化评分(Sheth指数、APRI指数、FIB-4指数),比较两组间上述指数、相关临床指标差异。计量资料两组间比较采用独立样本t检验或Mann-Whitney U秩和检验;计数资料两组间比较采用Fisher检验。应用Spearman秩相关对有差异的指标进一步分析,筛选出与肝纤维化程度相关的临床指标及评分标准,绘制受试者工作特征曲线(ROC曲线)并计算曲线下面积(AUC)。  结果  本研究患者多在儿童及青少年时期发病,其中有10例(38.5%)患者K-F环为阳性,17例(65%)患者处于进展期肝纤维化阶段。进展期和非进展期肝纤维化患者比较,WBC(Z=-2.102,P=0.036)、Hb(t=-2.860,P=0.009)、PLT(t=-4.053,P<0.001)、DBil(Z=-2.130,P=0.033)、Alb(t=-2.875,P=0.008)、Sheth指数(Z=-3.369,P=0.001)差异均有统计学意义。WBC、Hb、PLT、Alb水平与WD患者肝纤维化程度呈负相关(r值分别为-0.587、-0.610、-0.656、-0.411,P值均<0.05),DBil和Sheth指数与肝纤维化程度呈正相关(r值分别为0.486、0.711,P值均<0.05)。ROC曲线分析显示,WBC、DBil、Sheth指数、Hb、PLT、Alb的AUC均>0.7,其中Sheth指数的AUC最大,为0.908,其敏感度和特异度分别为70.6%和100.0%,阳性和阴性预测值分别为100.0%和64.3%。  结论  Sheth指数的诊断效能优于其余单一临床指标,对中国肝病型WD进展期肝纤维化有较好的鉴别能力。
  • 图  1  相关临床指标、Sheth指数对WD进展期肝纤维化诊断的ROC曲线

    表  1  两组临床指标及无创肝纤维化评分比较

    变量 全部患者 (n=26) 进展期纤维化组 (n=17) 非进展期纤维化组 (n=9) 统计值 P
    男/女(例) 14/12 8/9 6/3 0.429
    K-F环(有/无或未知,例) 10/16 7/10 3/6 1.000
    发病时年龄(岁) 19.77±14.37 20.18±16.34 19.00±10.52 t=0.195 0.847
    WBC(×109/L) 4.62(3.94~5.69) 4.14(3.68~5.32) 5.58(4.74~6.31) Z=-2.102 0.036
    Hb(g/L) 135.85±49.94 117.88±26.57 169.78±66.35 t=-2.860 0.009
    PLT(×109/L) 157.24±93.75 114.60±61.44 237.78±93.55 t=-4.053 <0.001
    ALT(U/L) 57.30(25.00~197.13) 52.60(23.00~150.00) 191.30(30.65~227.25) Z=-1.617 0.106
    AST(U/L) 68.00(24.40~108.80) 46.30(24.10~125.10) 71.80(25.30~103.30) Z=-0.081 0.936
    TBil(μmol/L) 16.05(10.18~25.78) 17.00(12.55~35.40) 9.70(7.55~23.85) Z=-1.913 0.056
    DBil(μmol/L) 5.45(2.50~9.75) 7.20(3.85~10.40) 2.50(1.20~6.30) Z=-2.130 0.033
    Alb(g/L) 38.30±6.28 36.34±6.61 42.01±3.45 t=-2.875 0.008
    GGT(U/L) 74.95(36.38~136.00) 82.00(41.30~139.00) 73.30(27.60~155.55) Z=-0.296 0.767
    ALP(U/L) 162.20(66.75~332.13) 193.90(68.00~333.75) 130.50(65.55~311.25) Z=-0.189 0.850
    Sheth指数 0.89(0.55~1.22) 0.98(0.80~1.59) 0.51(0.45~0.75) Z=-3.369 0.001
    FIB-4指数 3.92(0.80~5.56) 2.62(0.82~4.84) 5.66(0.73~13.88) Z=-1.644 0.100
    APRI指数 0.98(0.59~2.28) 1.72(0.69~3.31) 0.79(0.55~0.98) Z=-1.913 0.056
    下载: 导出CSV

    表  2  WD患者临床指标、无创肝纤维化评分与肝纤维化程度的相关性

    变量 95%CI r P
    WBC(×109/L) 3.36~9.04 -0.587 0.002
    Hb(g/L) 115.67~156.02 -0.610 0.001
    PLT(×109/L) 119.37~195.10 -0.656 <0.001
    DBil(μmol/L) 4.66~10.54 0.486 0.012
    Alb(g/L) 35.77~40.84 -0.411 0.037
    Sheth指数 0.70~1.43 0.711 <0.001
    下载: 导出CSV

    表  3  Sheth指数及相关临床指标对WD进展期肝纤维化的诊断效能结果

    变量 AUC P 预测临界值 敏感度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%)
    WBC 0.755 0.036 4.615×109/L 70.6 88.9 92.3 61.5
    DBil 0.758 0.033 2.800 μmol/L 88.2 55.6 78.9 71.4
    Sheth指数 0.908 0.001 0.905 70.6 100.0 100.0 64.3
    Hb 0.889 0.001 137.500 g/L 88.2 88.9 93.7 80.0
    PLT 0.869 0.002 172.500×109/L 88.2 77.8 88.2 77.8
    Alb 0.781 0.020 41.350 g/L 76.5 77.8 86.7 63.6
    下载: 导出CSV
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  • 收稿日期:  2020-09-07
  • 修回日期:  2020-10-09
  • 刊出日期:  2021-03-16
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