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GUCI评分在慢性HBV感染者肝纤维化无创诊断中的预测价值
Predictive value of Gteborg University Cirrhosis Index score in noninvasive diagnosis of liver fibrosis in patients with chronic hepatitis B virus infection
文章发布日期:2018年09月30日  来源:  作者:陶奔,曹雯君,鲍腾,等  点击次数:276次  下载次数:27次

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【摘要】:目的与经典的APRI评分和FIB-4指数2种无创肝纤维化血清学诊断模型进行比较,探讨GUCI评分对慢性HBV感染者肝纤维化程度的预测价值。方法收集2010年1月-2016年12月在安徽医科大学第二附属医院接受肝穿刺病理学检查的慢性HBV感染者846例,分为显著肝纤维化组(≥S2期,n=396)、严重肝纤维化组(≥S3期,n=204)、肝硬化组(S4期,n=100例);846例患者中ALT<2×ULN 491例,其中显著肝纤维化(≥S2期)275例、严重肝纤维化(≥S3期)143例、肝硬化(S4期)73例;846例患者中HBeAg阴性383例,其中显著肝纤维化(≥S2期)218例、严重肝纤维化(≥S3期)110例、肝硬化(S4期)55例。所有患者均行肝穿刺病理学检查,同时检测穿刺当天的血常规、肝功能、凝血功能等相关临床指标,根据检测的临床指标分别计算出GUCI评分、APRI评分和FIB-4指数值。符合正态分布的计量资料多组间比较采用方差分析;不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验;计数资料多组间比较采用χ2检验;3种血清学模型与肝纤维化分期的等级相关分析采用Spearman相关分析。绘制受试者工作特征曲线(ROC曲线),并利用ROC曲线分析3种肝纤维化血清学模型的诊断性能,ROC曲线下面积(AUC)间比较采用Z检验。结果GUCI评分、APRI评分、FIB-4指数与肝纤维化分期的相关系数r分别为0.472、0435、0.401,P值均<0.001;AST、PT-INR与乙型肝炎肝纤维化程度呈明显正相关(r分别为0.316和0.401,P值均<0.001);PLT与乙型肝炎肝纤维化程度呈明显负相关(r=-0.353,P<0.001)。GUCI评分诊断显著肝纤维化的AUC均高于APRI评分和FIB-4指数的AUC (Z值分别为6.291、3.159,P值均<0.001);GUCI评分诊断严重肝纤维化的AUC高于APRI评分的AUC (Z=5.306,P<0.000 1)。491例ALT<2×ULN 患者中,GUCI评分诊断显著肝纤维化的AUC高于APRI评分和FIB-4指数的AUC(Z值分别为5.969、3.089,P值均<0.01),GUCI评分诊断严重肝纤维化的AUC也高于APRI评分和FIB-4指数(Z值分别为4.455、3.192,P值均<0.01)。383例HBeAg阴性患者中,GUCI评分诊断显著肝纤维化的AUC均高于APRI评分和FIB-4指数的AUC (Z值分别为5.725、2.162,P值均<0.05);GUCI评分诊断严重肝纤维化的AUC高于APRI评分的AUC (Z=4.743,P<0.001)。在ALT<2×ULN患者中,以0.446分值为截断值,GUCI评分诊断显著肝纤维化的敏感度为61.82%,特异度为82.73%,阳性预测值为73.14%,阴性预测值为74.02,P<0.001;以0.492分值为截断值,GUCI评分诊断严重肝纤维化的敏感度为76.92%,特异度为72.30%,阳性预测值为44.49%,阴性预测值为91.56,P<0.001;以0.499分值为截断值,GUCI评分诊断肝硬化的敏感度为7200%,特异度为77.90%,阳性预测值为29.74%,阴性预测值为95.54%,P<0.001。结论GUCI评分是一种简单且实用的诊断肝纤维化的血清学模型,特别是对于ALT< 2×ULN的慢性HBV感染者,GUCI评分的诊断显著肝纤维化、严重肝纤维化的价值高于APRI评分、FIB-4指数;对于诊断肝硬化,GUCI评分与APRI评分、FIB-4指数的诊断价值基本相同。
【Abstract】:ObjectiveTo investigate the predictive value of Gteborg University Cirrhosis Index (GUCI) score in the noninvasive diagnosis of liver fibrosis stage in patients with chronic hepatitis B virus (HBV) infection by comparing it with the classical noninvasive serological diagnosis models of aspartate aminotransferase-to-platelet ratio index (APRI) score and fibrosis-4 (FIB-4) index for liver fibrosis. MethodsA total of 846 patients with chronic HBV infection who underwent liver biopsy in The Second Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were enrolled and divided into marked liver fibrosis (stage ≥S2) group with 396 patients, severe liver fibrosis (stage ≥S3) group with 204 patients, and liver cirrhosis (stage S4) group with 100 patients. Of all 846 patients, 491 had alanine aminotransferase (ALT) <2×upper limit of normal (ULN), among whom 275 had marked liver fibrosis (stage ≥S2), 143 had severe liver fibrosis (stage ≥S3), and 73 had liver cirrhosis (stage S4); there were 383 HBeAg-negative patients, among whom 218 had marked liver fibrosis (stage ≥S2), 110 had severe liver fibrosis (stage ≥S3), and 55 had liver cirrhosis (stage S4). Liver biopsy was performed for all patients, and clinical indices of routine blood test, liver function, and coagulation function were measured on the same day of liver biopsy to calculate GUCI score, APRI score, and FIB-4 index. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between multiple groups; the Spearman correlation analysis was used to investigate rank correlation between three serological models and liver fibrosis stage. The receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic efficacy of three serological models for liver fibrosis, and the Z test was used for comparison of the area under the ROC curve (AUC). ResultsGUCI score, APRI score, and FIB-4 index were positively correlated with liver fibrosis stage (r=0.472, 0.435, and 0.401, all P<0.001); aspartate aminotransferase (AST) level and prothrombin time-international normalized ratio (PT-INR) were positively correlated with liver fibrosis degree in patients with hepatitis B (r=0.316 and 0.401, both P<0.001); platelet count (PLT) was negatively correlated with liver fibrosis degree in patients with hepatitis B (r=-0.353, P<0.001). GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis (Z=6.291 and 3159, both P<0.001) and a higher AUC than APRI score in the diagnosis of severe liver fibrosis (Z=5.306, P<00001). In 491 patients with ALT<2×ULN, GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked or severe liver fibrosis (marked liver fibrosis: Z=5.969 and 3.089, both P<0.01; severe liver fibrosis: Z=4.455 and 3.192, both P<0.01). In 383 HBeAg-negative patients, GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis (Z=5.725 and 2.162, both P<0.05) and a higher AUC than APRI score in the diagnosis of severe liver fibrosis (Z=4.743, P<0.001). In the patients with ALT<2×ULN, at the cut-off value of 0.446, GUCI score had a sensitivity of 61.82%, a specificity of 82.73%, a positive predictive value of 73.14%, and a negative predictive value of 74.02% in the diagnosis of marked liver fibrosis (P<0.001); at the cut-off value of 0.492, GUCI score had a sensitivity of 76.92%, a specificity of 72.30%, a positive predictive value of 44.49%, and a negative predictive value of 91.56% in the diagnosis of severe liver fibrosis (P<0.001); at the cut-off value of 0.499, GUCI score had a sensitivity of 72.00%, a specificity of 77.90%, a positive predictive value of 29.74%, and a negative predictive value of 95.54% in the diagnosis of liver cirrhosis (P<0.001). ConclusionGUCI score is a simple and practical serological model for the diagnosis of liver fibrosis, especially for patients with chronic HBV infection with ALT<2×ULN. GUCI score has a higher value than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis and severe liver fibrosis; as for the diagnosis of liver cirrhosis, GUCI score has a similar diagnostic value as APRI score and FIB-4 index.
【关键字】:肝炎, 乙型, 慢性; 肝硬化; GUCI评分; 诊断
【Key words】:hepatitis B, chronic; liver cirrhosis; GUCI score; diagnosis
【引证本文】:TAO B, CAO WJ, BAO T, et al. Predictive value of Gteborg University Cirrhosis Index score in noninvasive diagnosis of liver fibrosis in patients with chronic hepatitis B virus infection[J]. J Clin Hepatol, 2018, 34(11): 2334-2340. (in Chinese) 陶奔, 曹雯君, 鲍腾, 等. GUCI评分在慢性HBV感染患者肝纤维化无创诊断中的预测价值[J]. 临床肝胆病杂志, 2018, 34(11): 2334-2340.

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