多项无创诊断指数评估慢性乙型肝炎肝纤维化的准确性比较*

doi:10.3969/j.issn.1672-5069.2017.06.014

摘要/Abstract

摘要： 目的探讨10种无创诊断肝纤维化指数对慢性乙型肝炎患者肝纤维化诊断的准确性。方法回顾性分析2008年1月~2014年12月期间行肝穿刺活检术诊断的1362例CHB患者的临床资料,分别计算不同的指数得分。以受试者工作特征曲线下面积（AUROC）评价各指数的准确性,采用DeLong法对各指数诊断的准确性进行比较。结果本组资料显示,诊断显著肝纤维化（≥S2）的AUROC依次为：S指数（0.745）、GPRI （0.736）和APRI （0.681）;诊断肝硬化（S4）的AUROC依次为：S指数（0.716）、FIB-4（0.708）和GPRI （0.707）;S指数诊断肝硬化时,其截断点为0.03,敏感度为98.8%,阴性预测值为97.0%,阴性似然比为0.14;截断点为1.5的特异度为99.5%,阳性预测值为70.0%,阳性似然比为10.1;S指数诊断显著肝纤维化时,其截断点为0.89,特异度为99.5%,阳性预测值为98.5%,阳性似然比为11.5;截断点为0.02的敏感度为97.7%,阴性预测值为40.0%,阴性似然比为0.26。结论在10个无创诊断指数中,S指数的诊断性能相对最佳,值得进一步研究。

关键词: 乙型肝炎, 肝纤维化, 常规血清指标, 无创诊断指数

Abstract: Objective To evaluate the diagnostic efficacy of ten noninvasive indexes for liver fibrosis in patients with chronic hepatitis B. Methods The data of 1362 patients with chronic hepatitis B between January 2008 and December 2014 were collected and statistically analyzed. Results For significant fibrosis diagnosis,the best AUROCs of S index,GPRI and APRI were 0.745,0.736 and 0.681,respectively;For cirrhosis diagnosis,the best AUROCs were S index（0.716）,FIB-4 （0.708） and GPRI 0.707,respectively;In diagnosing liver cirrhosis,the cut-off value of S index was 0.03,with a sensitivity of 98.8%,a negative predictive value of 97.0% and a negative likelihood ratio of 0.14;and the cut-off value 1.5 showed a specificity of 99.5%,a positive predictive value of 70.0% and a positive likelihood ratio of 10.1;For significant fibrosis diagnosis,the cut-off value of S index was 0.89,with a specificity of 99.5%,a positive predictive value of 98.5% and a positive likelihood ratio of 11.5;the cut-off value 0.02 showed a sensitivity of 97.7%,a negative predictive value of 40.0% and a negative likelihood ratio of 0.26. Conclusions S index has a relatively good accuracy and is superior to other nine noninvasive diagnostic indexes in diagnosing significant liver fibrosis in patients with chronic hepatitis B.

Key words: Hepatitis B, Liver fibrosis, Routine serum biomarker, Noninvasive indexes

张志侨, 黄丽雯, 陈永鹏. 多项无创诊断指数评估慢性乙型肝炎肝纤维化的准确性比较*[J]. 实用肝脏病杂志, 2017, 20(6): 692-696.

Zhang Zhiqiao, Huang Liwen, Chen Yongpeng. Evaluation of liver fibrosis by non-invasive diagnostic indexes in patients with chronic hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(6): 692-696.

参考文献

[1] Shackel NA,McCaughan GW. Liver biopsy:is it still relevant. Intern Med J,2006,36:689-691.
[2] Emanuele E. Is biopsy always necessary toward a clinico-laboratory approach for diagnosing nonalcoholic steatohepatitis in obesity. Hepatology,2008,48:2086-2087.
[3] Chen YP,Peng J,Hou JL. Non-invasive assessment of liver fibrosis in patients with chronic hepatitis B. Hepatol Int,2013,7（2）:356-368.
[4] Liang XE,Chen YP,Zhang Q,et al. Dynamic evaluation paralleled with bilirubin and ALT normalization to improve diagnostic accuracy of FibroScan in patients with hepatitis B exacerbation. J Viral Hepat,2011,18:884-891.
[5] Caste'ra L,Foucher J,Bernard PH,et al. Pitfalls of liver stiffness measurement:a 5-year prospective study of 13,369 examinations. Hepatology,2010,51:828-835.
[6] Vardar R,Vardar E,Demiri S,et al. Is there any non-invasive marker replace the needle liver biopsy predictive for liver fibrosis,in patients with chronic hepatitis Hepatogastroenterology,2009,56:1459-1465.
[7] Pohl A,Behling C,Oliver D,et al. Serum aminotransferase levels and platelet counts as predictors of degree of fibrosis in chronic hepatitis C virus infection. Am J Gastroenterol,2001,96（11）:3142-3146.
[8] Valet-Pichard A,Mallet V,Nalpas B,et al.FIB-4:an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and Fibrotest. Hepatology,2007,46（1）:32-36.
[9] Wai CT,Greenson JK,Fontana RJ,et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology,2003,38:518-526.
[10] Williams AL,Hoofnagle JH. Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis. Gastroenterology,1988,95（3）:734-739.
[11] Zhou K,Gao CF,Zhao YP,et al. Simpler score of routine laboratory tests predicts liver fibrosis in patients with chronic hepatitis B. J Gastroenterol Hepatol,2010,25（9）:1569-1577.
[12] Mohamadnejad M,Montazeri G,Fazlollahi A,et al. Noninvasive markers of liver fibrosis and inflammation in chronic hepatitis B-virus related liver disease. Am J Gastroenterol,2006,101（11）:2537-2545.
[13] Fung J,Lai CL,Fong DY,et al. Correlation of liver biochemistry with liver stiffness in chronic hepatitis B and development of a predictive model for liver fibrosis. Liver Int,2008,28:1408-1416.
[14] Poynard T,Bedossa P. Age and platelet count:a simple index for predicting the presence of histological lesions in patients with antibodies to hepatitis C virus. METAVIR and CLINIVIR Cooperative Study Groups. J Viral Hepat,1997,4:199-208.
[15] Lee IC,Chan CC,Huang YH,et al. Comparative analysis of noninvasive models to predict early liver fibrosis in hepatitis B e antigen-negative chronic hepatitis B. J Clin Gastroenterol,2011,45（3）:278-285.
[16] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南（2010年版）. 实用肝脏病杂志,2011,14（2）：81-89.
[17] European Association for the study of the liver. EASL clinical practice guidelines:management of chronic hepatitis B. J Hepatol,2009,50:227-242.
[18] Poynard T,Halfon P,Castera L,et al. Standardization of ROC curve areas for diagnostic evaluation of liver fibrosis markers based on prevalences of fibrosis stages. Clin Chem,2007,53: 1615-1622.
[19] Poynard T,Halfon P,Castera L,et al. Standardization of ROC curve areas for diagnostic evaluation of liver fibrosis markers based on prevalences of fibrosis stages. Clin Chem,2007,53:1615-1622.
[20] Swets JA. Measuring the accuracy of diagnostic systems. Science,1988,240:1285-1293.
[21] Jaeschke R,Guyatt GH,Sackett DL,et al. Users' guides to the medical literture III. How to use an article about a diagnostic test B. What are the results and will they help me in caring for my patients. JAMA,1994,271:703-707.
[22] Basar O,Yimaz B,Ekiz F,et al. Non-invasive tests in prediction of liver fibrosis in chronic hepatitis B and comparison with post-antiviral treatment results. Clin Res Hepatol Gastroenterol,2013,37（2）:152-158.
[23] Zeng X,Xu C,He D,et al. Performance of several simple,noninvasive models for assessing significant liver fibrosis in patients with chronic hepatitis B. Croat Med J,2015,56（3）:272-279.
[24] Liang XE,Zhong C,Huang L,et al. Optimization of hepatitis B cirrhosis detection by stepwise application of transient elastography and routine biomarkers. J Gastroenterol Hepatol,2017,32:459-465.