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目的研究确定HBV感染者的体征、年龄、脾脏厚度、HBV状态积分及其评估肝纤维化的价值。方法回顾性分析420例做过肝活检的HBV慢性感染者的慢性肝病体征、年龄、脾脏厚度、HBV状态等指标与肝病理分级分期的关系,根据条件logistic回归分析建立评估纤维化积分模型,然后用受试者工作特征曲线下面积进行分析。结果脾脏厚度、年龄、HBV-DNA与肝病理分级分期的Spearman等级相关性系数分别为0.3995(P<0.01)、0.1962(P>0.05)、-0.0521(P>0.05),慢性肝病体征、性别、e抗原状态与肝组织纤维化程度的R×2表线性趋势分析的χ2值分别为76.702(P<0.01)、14.931(P<0.01)、4.0721(P<0.05);慢性肝病体征、病毒状态、脾脏厚度、年龄与肝硬化相关的条件logistic回归系数分别为1.6101(P<0.01)、0.9256(P<0.05)、0.4437(P<0.01)、0.5251(P<0.01),依据回归系数设计各指标积分份额而建立的积分模型诊断肝硬化(S4)受试者工作特征曲线下面积为0.7485,临界值诊断肝硬化的敏感度为60.16%,特异度为75.68%,准确度为70.95%,阳性预测值52.03%,阴性预测值81.25%,阳性似然比2.47,阴性似然比0.53;低积分者78.31%是轻度肝纤维化,高积分者65.63%是肝硬化。结论以慢性肝病体征、病毒状态、脾脏厚度、年龄指标建立的积分模型对评估肝纤维化程度具有一定价值。
OBJECTIVE: To determine the signs, ages, spleen thickness, HBV status scores and the value of evaluating liver fibrosis in patients with HBV infection. Methods A retrospective analysis of 420 chronic HBV-infected patients with liver biopsy chronic liver disease signs, age, splenic thickness, HBV status and other indicators of liver histology and staging of the relationship between the conditions based on conditional logistic regression analysis established fibrosis integral model, and then The area under the receiver operating characteristic curve was analyzed. Results The Spearman rank correlation coefficient of spleen thickness, age, HBV-DNA and hepatic pathological grading were 0.3995 (P <0.01), 0.1962 (P> 0.05) The chi2 values of linear regression analysis of R * 2 with e antigen status and liver fibrosis were 76.702 (P <0.01), 14.931 (P <0.01) and 4.0721 (P <0.05) The logistic regression coefficients of spleen thickness, age and cirrhosis were 1.6101 (P <0.01), 0.9256 (P <0.05), 0.4437 (P <0.01) and 0.5251 (P <0.01) (S4) in patients with cirrhosis (S4) was 0.7485. The sensitivity of the critical value in diagnosing cirrhosis was 60.16%, the specificity was 75.68%, the accuracy was 70.95%. The positive predictive value 52.03%, negative predictive value 81.25%, positive likelihood ratio 2.47, negative likelihood ratio 0.53; low score 78.31% were mild hepatic fibrosis, high score 65.63% were cirrhosis. Conclusion The integral model established by chronic liver disease sign, virus state, spleen thickness and age index is of certain value in assessing the degree of liver fibrosis.