四种诊断模型诊断乙型肝炎病毒携带者肝纤维化的效能分析*

doi:10.3969/j.issn.1672-5069.2019.06.014

摘要/Abstract

摘要： 目的探讨应用基于4因子模型（FIB-4）、肝脏瞬时弹性探测仪（FS）、天冬氨酸氨基转移酶/丙氨酸氨基转移酶比率（AAR）和天冬氨酸氨基转移酶/血小板比值指数（APRI）诊断乙型肝炎病毒（HBV）携带者肝纤维化的效能。方法 2015年7月~2017年11月我院收治的203例慢性HBV携带者,均符合《慢性乙型肝炎防治指南》中相关诊断标准。使用FS行肝硬度测定（LSM）,并根据临床检测结果,获得FIB-4、APRI和AAR计算结果。常规行肝活检,行肝组织病理学检查,将≥S2定义为显著肝纤维化。应用ROC曲线分析4种指标诊断显著肝纤维化的效能。结果在203例慢性HBV携带者中,经病理学检查,诊断为S0期24例（11.8%）,S1期143例（70.4%）,S2期32例（15.8%）,S3期3例（1.48%）,S4期l例（0.5%）,其中≥S2期者36例（17.7%）;36例≥S2期患者FIB-4为（2.2±1.6）,显著大于167例<S2期的（1.3±0.9）,显著肝纤维化人群LSM、AAR和APRI均显著大于无显著肝纤维化人群【分别为（15.3±5.1）对（6.3±4.2）、（0.8±0.4）对（0.5±0.1）、（1.0±0.6）对（0.5±0.2）,P<0.01】;ROC曲线分析显示,LSM诊断显著肝纤维化的AUC为0.967（95%CI 0.945~0.990）,其灵敏度为94.4%,特异度为86.0%,AAR诊断的AUC为0.8（95%CI 0.821~0.966）,其灵敏度为72.2%,特异度为99.4%,APRI诊断的AUC为0.884（95%CI 0.810~0.958）,其灵敏度为72.2%,特异度为99.8%, FIB4诊断的AUC为0.792（95%CI 0.689~0.895）,其灵敏度为69.4%,特异度为90.1%。结论应用无创诊断模型诊断HBV携带者显著性肝纤维化有一定的意义,对指导临床处理有帮助,但还需大样本多中心研究证实。

关键词: 乙型肝炎病毒携带者, 肝纤维化, 无创诊断, 效能

Abstract: Objective To investigate the diagnostic efficacy of four non-invasive diagnostic models in evaluating significant liver fibrosis in chronic asymptomatic hepatitis B virus carriers（ASC）. Methods 203 chronic ASCs were recruited in ourhospital between July 2015 and November 2017,and FIB-4 scoring systems,liver stiffness measure（LSM） by Fibroscan,aspartate aminotransferase/alanine aminotransferase ratio（AAR） and aspartate aminotransferase/platelet ratio index（APRI） were obtained. The liver biopsies were performed,and≥S2 was defined as significant liver fibrosis. The diagnostic efficacy was evaluated by area under ROC. Results Out of the 203 chronic ASCs,the liver histopathological examination showed that no liver fibrosis in 24（11.8%）,S1 in 143（70.4%）,S2 in 32（15.8%）,S3 in 3（1.48%） and S4 in l（0.5%）,with 36（17.7%） having ≥S2 liver fibrosis;the FIB-4 in 36 ASCs with ≥S2 was （2.2±1.6）,significantly higher than （1.3±0.9） in 167 with less than S2,and the LSM,AAR and APRI scores in ASCs with significant liver fibrosis were all significant higher than in those with less than S2 liver fibrosis [（15.3±5.1） vs. （6.3±4.2）,（0.8±0.4） vs. （0.5±0.1）,and （1.0±0.6） vs. （0.5±0.2）,P<0.01];the AUC in predicting significant liver fibrosis by LSM was 0.967（95%CI 0.945 to 0.990）,with sensitivity （Se） of 94.4% and specificity （Sp） of 86.0%,and that by AAR was 0.8（95%CI 0.821 to 0.966）,with Se of 72.2% and Sp of 99.4%,by APRI was 0.884（95%CI 0.810 to 0.958）,with Se of 72.2% and Sp of 99.8%,and by FIB4 was 0.792（95%CI 0.689 to 0.895）,with Se of 69.4% and Sp of 90.1%. Conclusion The application of the four non-invasive diagnostic model in predicting significant liver fibrosis in ASCs might help clinical managements,which warrants further multi-centre investigation.

Key words: Asymptomatic hepatitis B viral carriers, Liver fibrosis, Non-invasive diagnostic diag-

吴海义, 陈建新. 四种诊断模型诊断乙型肝炎病毒携带者肝纤维化的效能分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 832-835.

chronic hepatitis B virus carriers Wu Haiyi, Chen Jianxin.. Diagnostic efficacy of four non-invasive diagnostic models in evaluating significant liver fibrosis in[J]. Journal of Practical Hepatology, 2019, 22(6): 832-835.

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四种诊断模型诊断乙型肝炎病毒携带者肝纤维化的效能分析^*

Diagnostic efficacy of four non-invasive diagnostic models in evaluating significant liver fibrosis in

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