多种无创检测指标预测自身免疫性肝病患者肝硬化效能比较*

doi:10.3969/j.issn.1672-5069.2024.04.011

摘要/Abstract

摘要： 目的评估无创检测指标诊断自身免疫性肝病(AILDs)患者肝硬化的效能。方法 2017年4月～2020年9月我院诊治的自身免疫性肝炎(AIH)患者93例和自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)患者37例,均接受肝活检,并常规检测获得门冬氨酸氨基转移酶/血小板计数比值(APRI) 、基于4因子的纤维化指数 (FIB-4)、门冬氨酸氨基转移酶-丙氨酸氨基转移酶(AAR)和肝脏硬度检测(LSM),绘制受试者工作特征曲线(ROC),并计算曲线下面积(AUROC),评估诊断效能。结果肝组织病理学检查显示,在AIH患者中,发现肝硬化21例(22.6%),在AIH-PBC OS患者中,发现肝硬化6例(16.2%);无论在AIH组还是AIH-PBC OS组,肝硬化患者LSM、FIB-4和AAR都显著高于非肝硬化组(P＜0.05);LSM、FIB-4和AAR诊断AIH患者肝硬化的截断点分别为17.7 kPa、3.6和1.1,其诊断的AUC分别为0.876、0.783和0.745;LSM、FIB-4和AAR诊断AIH-PBC OS患者肝硬化的截断点分别为22.9 kPa、7.7和1.0,其诊断的AUC分别为0.989、0.914和0.833,均以LSM的诊断效能最高。结论无创检测指标LSM、FIB-4和AAR诊断AILDs患者肝硬化具有很大的临床应用价值,适合普查和筛查。

关键词: 自身免疫性肝病, 自身免疫性肝炎, 自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征, 肝硬化, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of four noninvasive indexes in predicting liver cirrhosis (LC) in patients with autoimmune liver diseases (AILDs). Methods 130 patients with AILDs, including autoimmune hepatitis (AIH) in 93 cases and autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC OS) in 37 cases, were encountered in our hospital between April 2017 and September 2020, and all underwent liver biopsies. Aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4), aspartate aminotransferase to alanine aminotransferase ratio (AAR) and liver stiffness measurement (LSM) were routinely obtained. Diagnostic efficacy was assessed by area under receiver operating characteristic curve (AUROC). Results Liver histopathological examination showed LC in 21 patients (22.6%) from AIH and 6 patients (16.2%) from AIH-PBC OS; no matter in patients with AIH or with AIH-PBC OS, LSM, FIB-4 and AAR in patients with LC were significantly higher than in those without (P＜0.05); the AUCs were 0.876, 0.783 and 0.745 in predicting LC in patients with AIH, when LSM, FIB-4 and AAR greater than 17.7 kPa, 3.6 and 1.1 were set as the cut-off-values, and the AUCs were 0.989, 0.914 and 0.833 in predicting LC in patients with AIH-PBC OS, when LSM, FIB-4 and AAR greater than 22.9 kPa, 7.7 and 1.0 were set as the cut-off-values. Conclusion Noninvasive LSM, FIB-4 and AAR could predict LC in patients with AILDs, which might be helpful for screening and early diagnosis.

Key words: Autoimmune liver diseases, Autoimmune hepatitis, Autoimmune hepatitis-primary biliary cholangitis overlap syndrome, Liver cirrhosis, Diagnosis

任浩, 熊清芳. 多种无创检测指标预测自身免疫性肝病患者肝硬化效能比较^*[J]. 实用肝脏病杂志, 2024, 27(4): 535-538.

Ren Hao, Xiong Qingfang. Diagnostic performance of fournoninvasive detection indexes in predicting liver cirrhosis in patients with autoimmune liver diseases[J]. Journal of Practical Hepatology, 2024, 27(4): 535-538.

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多种无创检测指标预测自身免疫性肝病患者肝硬化效能比较^*

Diagnostic performance of fournoninvasive detection indexes in predicting liver cirrhosis in patients with autoimmune liver diseases

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