无创诊断模型诊断乙型肝炎和肝硬化患者肝纤维化价值评价

doi:10.3969/j.issn.1672-5069.2016.05.017

摘要/Abstract

摘要： 目的探讨基于Logistic回归及ROC曲线评估无创诊断模型诊断肝纤维化（LF）和肝硬化的价值。方法在我院收治的慢性乙型肝炎患者58例,代偿期乙型肝炎肝硬化患者84例,失代偿期乙型肝炎肝硬化患者35例,常规进行Fibroscan检测获取肝脏硬度（LSM）值,分析其与血常规、凝血功能、纤维化指标等的相关性,建立Logistic回归模型及ROC曲线,应用AUC评价其诊断价值。结果乙型肝炎、代偿期和失代偿期肝硬化患者LSM值分别为5.2（4.2~7.3） kPa、8.8（5.8~15.5） kPa和12.2（8.9~20.0） kPa,差别有统计学意义（P<0.05）;Frons与 FIB-4、RPR、PLT呈正相关（r=0.93、r=0.89、r=-0.91,P<0.01）,APRI与FIB-4、PLT呈正相关（r=0.83、r=-0.80,P<0.01）,FIB-4与RPR、PLT呈正相关（r=0.86、r=-0.87,P<0.01）,RPR与PLT呈负相关（r=-0.98,P<0.01）,CIV与PCIII呈正相关（r=0.89,P<0.01）;Logistic预测模型（PRE）具有较高的诊断价值(AUC为0.86,Se=0.86,Sp=0.78,诊断准确率为80%）。结论在单项指标中,Fibroscan检测在诊断慢性乙型肝炎肝纤维化方面有较好的应用价值。在综合诊断模型中,预测模型明显好于单项模型。

关键词: 慢性乙型肝炎, 肝硬化, Fibroscan, 肝纤维化：血清学指标, 无创诊断模型

Abstract: Objective To explore the noninvasive diagnostic model based on Logistic regression and ROC curve in liver fibrosis and cirrhosis. Methods 58 patients with chronic hepatitis B（CHB）,84 with compensated cirrhosis and 35 with decompensated cirrhosis were included in this study. Fibroscan was conducted to obtain liver stiffness measurement（LSM） in all the patients,and serological examination were carried out. Logistic regression,plotted ROC curve and area under ROC curve（AUC） were applied to assess the diagnostic value of all the diagnostic model. Results The LSM were 5.2（4.2~7.3） kPa,7.3（5.8~15.5） kPa and 12.2（8.9~20.0） kPa in patients with CHB,compensated and decompensated cirrhosis,respectively（P<0.05）;Frons index was strongly positively correlated to fibrosis index based on the 4 factors（Fib-4）,red blood cell volume distribution width （RDW） to platelet ratio（RPR）,and PLT counts（r=0.93,r=0.89,r=-0.91,P<0.01）;aspartate aminotransferase-to-platelet ratio index（APRI） was positively correlated to FIB-4 or PLT（r=0.83,r=-0.80,P<0.01）;FIB-4 was positively correlated to RPR or PLT （r=0.86,r=-0.87,P<0.01）;RPR was negatively correlated to PLT （r=-0.98,P<0.01）;ROC curve analysis showed that the diagnostic accuracy of Logistic prediction model（PRE） was 80%,and the area under the curve（AUC） was 0.86 with the sensitivity and specificity of 86% and 78%,respectively. Conclusion Fibroscan detection has a promising value in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B and the prediction models are noninvasive procedure in clinical practice.

Key words: Hepatitis B, Cirrhosis, Fibroscan, Serological index, Hepatic fibrosis, Noninvasive diagnosis models

钤培国, 廉晓晓, 郭晓霞. 无创诊断模型诊断乙型肝炎和肝硬化患者肝纤维化价值评价[J]. 实用肝脏病杂志, 2016, 19(5): 578-582.

Qian Peiguo, Lian Xiaoxiao, Guo Xiaoxia.. Application of noninvasive diagnostic model in diagnosis of liver fibrosis in patients with hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2016, 19(5): 578-582.

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