关键词: 慢性乙型肝炎, 肝纤维化, γ-谷氨酰转肽酶, 胆碱酯酶, 诊断

Abstract: Objective The purpose of this study was to evaluate the diagnostic value of gamma-glutamyl transpeptidase to cholinesterase ratio (GCR) in predicting hepatic fibrosis in patients with chronic hepatitis B (CHB). Methods 1335 HBeAg-positive and 1026 HBeAg-negative patients were enrolled in this study. The liver histological assessment by Scheuer scoring system was done, and the fibrotic staging ≥S2 and =S4 were defined as significant fibrosis and cirrhosis, respectively. Results Out of serum HBeAg positive patients, 886 cases were found to have significant fibrosis and 286 cases were having liver cirrhosis, and out of serum HBeAg negative patients, 556 cases having significant fibrosis and 202 having cirrhosis; in HBeAg-positive patients, the area under ROC curve (AUC) by GCR in predicting significant fibrosis was 0.770 (95%CI :0.747-0.793), significantly greater than [0.757 (95%CI:0.733-0.780) by gamma-glutamyltranspeptidase to platelet ratio (GPR, P<0.05), and in predicting cirrhosis was 0.816 (95%CI:0.794-0.837), which was close to that by GPR ; in HBeAg-negative patients, the AUC by GCR in predicting significant fibrosis was 0.761 (95%CI:0.733-0.787), which was close to that by GPR [0.758 (95%CI:0.731-0.784), and in predicting cirrhosis was 0.838 (95%CI:0.814-0.860), which was also close to that by GPR ; we set the GCR>0.100 and GPR>0.500 as the cut-off-value, the specificities in predicting significant fibrosis in HBeAg-positive patients were 81.5% and 80.6%, and in HBeAg-negative patients were 81.5% and 79.4%, respectively; the sensitivities in predicting cirrhosis in HBeAg-positive patients were 84.3% and 81.5%, and in HBeAg-negative patients were 79.2% and 82.7%, respectively. Conclusion The diagnostc performance of GCR in predicting significant fibrosis and cirrhosis in patients with CHB is higher than or close to that by GPR, which needs further investigation.

Key words: Hepatitis B, Fibrosis, Gamma-glutamyl transpeptidase, Cholinesterases, Diagnosis