Evaluation of liver fibrosis by non-invasive diagnostic indexes in patients with chronic hepatitis B
- Author:
- No author available
- Journal Title:
- World Chinese Journal of Digestology
- Issue:
- 22
- DOI:
- 10.11569/wcjd.v28.i22.1137
- Key Word:
- 肝纤维化;慢性乙型肝炎;无创性;模型
Abstract： 背景 肝活检是判断乙型肝炎肝纤维化的金标准,因其为有创的检查,临床应用有一定局限性,因此无创性诊断的评估受到关注.目的 评价10个无创模型指数对慢性乙型肝炎肝纤维化的诊断价值.方法 收集2003-06至2019-08间的慢性乙型肝炎患者1030例,所有病例均接受了肝活检,并同时检测了血液、B超等指标.按照公式计算模型的指数分别为天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AST-to-ALT ratio,AAR)、AST/血小板计数比值(AST-to platelet ratio index,APRI)、年龄-血小板指数(age platelet index,API)、肝硬化判别式值(cirrhosis discriminant score,CDS)、FIB-4指数(fibrosis index based on the four factors,FIB-4)、γ-谷氨酰转肽酶/血小板计数(gamma-glutamyltranspeptidase to platelet ratio,GPR)、S指数(S-index,S)、脾脏/血小板比值指数(spleen to platelet ratio index,SPRI)、年龄-脾脏/血小板比值指数(age-spleen to platelet ratio index,ASPRI),FV(作者的模型),并利用ROC曲线下面积(area under receiver operating characteristiccurve,AUROC)评价每个模型在肝纤维化诊断中的临床价值.结果 所有模型指数均与肝纤维化分期相关(r = 0.215、0.382、0.629、0.449、0.612、0.618、0.654、0.658、0.707、0.775,均P＜0.05).诊断F2-3的AUROC较好的为:FV(0.834)和ASPRI(0.796),灵敏度为78.8％和70.2％,特异度为74.0％和76.1％,准确率分别为76.3％和73.3％.F4为:FV(0.928)和ASPRI(0.912),灵敏度为85.4％和89.4％,特异度为85.0％和77.3％,阴性预测值为96.2％和96.5％、阴性似然比为0.172和0.137、准确率为85.1％和79.7％.结论 FV和ASPRI是各项无创模型中诊断价值准确率最好的,尤其诊断早期肝硬化方面更具优势.
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