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目的探讨综合预测模型FibroTest对慢性乙型肝炎肝纤维化的诊断价值。方法留取2002年8月至2005年12月北京大学第一医院、安阳市第五人民医院和无锡市传染病医院的123例行肝活检的慢性乙型肝炎患者的血清,检测α2-巨球蛋白、结合珠蛋白、载脂蛋白-AⅠ、记录总胆红素和谷氨酰转肽酶的数值,并根据其结果结合患者的年龄和性别计算出FibroTest的数值。根据肝纤维化分期设定3个判定点,分别为显著纤维化(S2~S4期),严重纤维化(S3~S4期)和肝硬化(S4期)。以肝活检病理结果为金标准绘制出FibroTest的受试者工作特征曲线,计算曲线下面积(AUC),并与用天冬氨酸转氨酶-血小板比值指数(APRI)计算出的AUC进行比较,评价其对慢性乙型肝炎肝硬化的诊断价值。结果123例肝活检患者中S0期25例(20.3%);S1期27例(22.0%);S2期31例(25.2%);S3期29例(23.6%);S4期11例(8.9%),即显著纤维化者(S2~S4期)71例(57.7%),严重纤维化者(S3~S4期)40例(32.5%),肝硬化者(S4期)11例(8.9%)。FibroTest对3个判定点的AUC值分别为0.814(95%CI:0.740~0.888,P<0.01),0.824(95%CI:0.749~0.898,P<0.01),0.723(95%CI:0.575~0.870,P=0.015)。而APRI对3种不同程度肝纤维化的AUC值分别为0.715(95%CI:0.625~0.805,P=0.001),0.725(95%CI:0.631~0.818,P=0.002)和0.646(95%CI:0.497~0.795,P>0.05)。结论Fi-broTest可以准确地估计慢性乙型肝炎患者有无显著纤维化,可使45.5%的患者避免进行肝脏活检,并保证87.5%的诊断准确率。
Objective To investigate the diagnostic value of FibroTest, a comprehensive prediction model, in the diagnosis of chronic hepatitis B liver fibrosis. Methods Totally 123 serum samples from patients with chronic hepatitis B who underwent liver biopsy from the First Hospital of Peking University, the Fifth People’s Hospital of Anyang City and the Wuxi Infectious Diseases Hospital from August 2002 to December 2005 were collected for detection of α2- Protein, haptoglobin, apolipoprotein-AI, the total bilirubin and glutamyl transpeptidase were recorded, and the value of FibroTest was calculated based on the age and sex of the patient based on the results. According to the staging of liver fibrosis, three decision points were set, which were significant fibrosis (S2 ~ S4), severe fibrosis (S3 ~ S4) and cirrhosis (S4). Subjects working curves for FibroTest were plotted against the liver biopsy pathology and the area under the curve (AUC) was calculated and compared with the AUC calculated using the aspartate aminotransferase-platelet ratio index (APRI) Its diagnosis of chronic hepatitis B cirrhosis. Results Twenty-five patients (20.3%) had S0 in 123 liver biopsies, 27 patients in S1 (22.0%), 31 patients in S2 (25.2%), 29 patients (23.6%) in S3 and 11 patients (8.9% ) Were 71 (57.7%) in patients with significant fibrosis (S2 ~ S4), 40 (32.5%) in severe fibrosis (S3 ~ S4) and 11 (8.9%) in patients with cirrhosis . The AUC of FibroTest for the three decision points were 0.814 (95% CI: 0.740-0.888, P <0.01), 0.824 (95% CI 0.749-0.898, P <0.01) and 0.723 (95% CI 0.575-0.870 , P = 0.015). The AUC of APRI for three different degrees of liver fibrosis were 0.715 (95% CI: 0.625-0.805, P = 0.001), 0.725 (95% CI 0.631-0.818, P 0.002) and 0.646 : 0.497 ~ 0.795, P> 0.05). Conclusion Fi-broTest can accurately estimate the presence or absence of significant fibrosis in patients with chronic hepatitis B, which can prevent the liver biopsy in 45.5% of patients and ensure the diagnostic accuracy of 87.5%.