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5种血清无创模型对慢性乙型肝炎肝纤维化分期诊断价值的比较

周新兰 王雁冰 陆伟 李秀芳 黄丹 张占卿 丁荣蓉

周新兰,王雁冰,陆伟,等. 5种血清无创模型对慢性乙型肝炎肝纤维化分期诊断价值的比较[J]. 临床肝胆病杂志, 2021, 37(7): 1567-1571. DOI: 10.3969/j.issn.1001-5256.2021.07.018
引用本文: 周新兰,王雁冰,陆伟,等. 5种血清无创模型对慢性乙型肝炎肝纤维化分期诊断价值的比较[J]. 临床肝胆病杂志, 2021, 37(7): 1567-1571. DOI: 10.3969/j.issn.1001-5256.2021.07.018
ZHOU XL, WANG YB, LU W, et al. Value of five noninvasive serum models in the diagnosis of chronic hepatitis B liver fibrosis[J]. J Clin Hepatol, 2021, 37(7): 1567-1571. DOI: 10.3969/j.issn.1001-5256.2021.07.018
Citation: ZHOU XL, WANG YB, LU W, et al. Value of five noninvasive serum models in the diagnosis of chronic hepatitis B liver fibrosis[J]. J Clin Hepatol, 2021, 37(7): 1567-1571. DOI: 10.3969/j.issn.1001-5256.2021.07.018

5种血清无创模型对慢性乙型肝炎肝纤维化分期诊断价值的比较

DOI: 10.3969/j.issn.1001-5256.2021.07.018
基金项目: 

上海市公共卫生临床中心院级基金 KSF0576

详细信息
    通讯作者:

    丁荣荣, dingrongrong@shphc.org.cn

  • 中图分类号: R512.62; R575.2

Value of five noninvasive serum models in the diagnosis of chronic hepatitis B liver fibrosis

Funds: 

Shanghai Public Health Clinical Center Hospital-level Funding KSF0576

  • 摘要:   目的  评价AST/PLT比值指数(APRI)、纤维化评分(FIB-4)、GGT与PLT比值(GPR)、哥德堡大学肝硬化指数(GUCI)评分和King's评分对慢性乙型肝炎(CHB)患者肝纤维化分期的诊断价值。  方法  选取2016年1月—2018年12月于上海市公共卫生临床中心肝胆内科住院期间接受肝组织活检及常规实验室检查的CHB患者612例。依据Scheuer方法进行炎症分级(G)和纤维化分期(S),并依据临床指标分别计算APRI、FIB-4、GPR、GUCI评分和King's评分。符合正态分布的计量资料两组间比较采用t检验,非正态分布计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验。两变量间相关性应用Spearman相关分析。采用受试者工作特征曲线下面积(AUC)比较诊断性能。  结果  GPR、APRI、FIB-4、King's评分和GUCI评分在S1~2与S3~4组间比较差异均有统计学意义(Z值分别为8.683、7.372、6.294、7.204和7.795,P值均<0.001)。GPR、APRI、FIB-4、King's评分和GUCI评分与肝纤维化分期均呈正相关(r值分别是0.54、0.48、0.44、0.48、0.49,P值均<0.001)。GPR诊断≥S2、≥S3和S4的AUC分别为0.76、0.80和0.82;APRI诊断≥S2、≥S3和S4的AUC分别为0.75、0.75和0.74;FIB-4诊断≥S2、≥S3和S4的AUC分别为0.70、0.75和0.78;King's评分诊断≥S2、≥S3和S4的AUC分别为0.74、0.76和0.77;GUCI评分诊断≥S2、≥S3和S4的AUC分别为0.75、0.76和0.76。  结论  相较于APRI、FIB-4、GUCI评分和King's评分,GPR对CHB肝纤维化分期的诊断效能最佳。

     

  • 表  1  纳入CHB患者的临床资料

    指标 所有患者(n=612) S1~2(n=405) S3~4(n=207) 统计值 P
    男性[例(%)] 402 (65.7) 257 (63.5) 145 (70.0) χ2=2.641 0.104
    年龄(岁) 37(31~46) 38(31~45) 37(31~46) Z=-0.694 0.488
    HBeAg阳性[例(%)] 333 (54.4) 203(50.1) 130 (62.8) χ2=8.877 0.003
    ALT(U/L) 60 (30~142) 52 (25~126) 78 (39~180) Z=4.027 <0.001
    AST(U/L) 42 (25~89) 34 (22~70) 59(36~114) Z=4.656 <0.001
    TBil(μmol/L) 13.8 (9.8~19.6) 12.4(9.2~17.2) 17.3(11.3~27.5) Z=4.426 <0.001
    GGT(U/L) 37(20~83) 28 (17~52) 68(36~117) Z=6.880 <0.001
    Alb(g/L) 42.0(39.3~44.5) 42.6(40.3~45.3) 40.1(37.5~43.4) Z=-4.438 <0.001
    血小板计数(×109/L) 156.00±56.80 172.39±52.08 124.86±52.36 t=-8.011 <0.001
    GPR 0.51 (0.25~1.24) 0.35 (0.19~0.67) 1.13 (0.58~2.28) Z=8.683 <0.001
    APRI 0.78 (0.39~1.67) 0.55 (0.33~1.12) 1.39 (0.81~2.78) Z=7.372 <0.001
    FIB-4 1.39 (0.92~2.42) 1.19 (0.81~1.76) 2.34 (1.34~4.31) Z=6.294 <0.001
    King's评分 11.78(6.21~26.26) 8.57(5.12~17.32) 24.96(11.51~54.56) Z=7.204 <0.001
    GUCI评分 0.83(0.41~1.85) 0.57(0.35~1.21) 1.51(0.87~3.28) Z=7.795 <0.001
    下载: 导出CSV

    表  2  5种无创模型诊断肝纤维化分期的效能分析

    诊断模型 ≥S2 ≥S3 S4
    AUC 95%CI P AUC 95%CI P AUC 95%CI P
    GPR 0.76 0.73~0.78 <0.001 0.80 0.77~0.82 <0.001 0.82 0.80~0.84 <0.001
    APRI 0.75 0.73~0.78 <0.001 0.75 0.72~0.77 <0.001 0.74 0.71~0.77 <0.001
    FIB-4 0.70 0.67~0.73 <0.001 0.75 0.72~0.77 <0.001 0.78 0.75~0.80 <0.001
    King's评分 0.74 0.71~0.76 <0.001 0.76 0.73~0.78 <0.001 0.77 0.74~0.80 <0.001
    GUCI评分 0.75 0.72~0.77 <0.001 0.76 0.73~0.78 <0.001 0.76 0.73~0.78 <0.001
    下载: 导出CSV

    表  3  5种无创模型诊断肝纤维化分期的临床价值

    诊断模型 截断值 敏感度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%) 阳性似然比 阴性似然比 准确度(%)
    ≥S2
      GPR 0.49 66.81 75.62 82.6 56.9 2.74 0.44 70.03
      APRI 0.76 64.96 74.63 81.6 55.2 2.55 0.47 68.50
      FIB-4 1.48 57.91 71.96 77.9 50.0 2.07 0.58 63.09
      King's评分 12.09 61.56 73.03 80.1 51.9 2.28 0.53 65.71
      GUCI评分 0.68 72.10 66.57 79.3 57.3 2.16 0.42 70.11
    ≥S3
      GPR 0.54 79.06 68.46 56.9 86.1 2.51 0.31 72.10
      APRI 0.80 76.70 65.15 53.7 84.2 2.20 0.36 69.04
      FIB-4 1.67 65.15 72.74 55.4 80.1 2.39 0.48 70.14
      King's评分 14.04 69.44 69.66 54.4 81.4 2.29 0.44 69.58
      GUCI评分 0.83 76.74 64.01 52.9 83.9 2.13 0.36 68.40
    S4
      GPR 0.72 77.83 84.14 43.2 92.7 3.78 0.30 79.21
      APRI 0.85 79.57 62.87 36.0 92.2 2.14 0.33 66.33
      FIB-4 2.44 59.51 73.23 49.1 84.2 2.91 0.48 74.20
      King's评分 15.25 77.72 65.04 36.5 91.9 2.22 0.34 67.54
      GUCI评分 0.88 80.86 61.04 35.5 92.3 2.08 0.31 65.20
    下载: 导出CSV
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  • 收稿日期:  2020-12-04
  • 修回日期:  2020-12-29
  • 刊出日期:  2021-07-20
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