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目的评估γ-谷胺酰转肽酶/血小板计数无创模型(GPR)对慢性乙型肝炎(简称乙肝)患者肝纤维化的诊断价值。方法共纳入2009年1月至2013年2月在北京地坛医院住院的慢性乙肝患者217例,根据肝组织病理学结果分为非显著性肝纤维化组178例(S0~S1)和显著性肝纤维化组39例(S2~S4)。分别对两组患者进行血常规、血清生物化学指标、乙肝病毒学标志物及HBV-DNA等检测。参考原始文献构建GPR、丙氨酸氨基转移酶/血小板计数模型(APRI)、基于4项因素的肝纤维化指数模型(FIB-4)3种预测肝纤维化的无创模型。采用SPSS19.0软件进行统计学处理,采用受试者工作特征曲线(ROC)方法评价比较不同无创模型预测慢性乙肝显著肝纤维化的诊断能力。结果两组患者APRI、FIB-4、GPR、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、血小板计数(Plt)、乙肝e抗原(HBe Ag)及HBV-DNA水平比较,差异均有统计学意义(P<0.05)。APRI、GPR、FIB-4,AST、碱性磷酸酶(ALP)和GGT与肝纤维化程度呈显著正相关(r=0.317、0.285、0.290、0.259、0.188、0.238),而Plt、HBe Ag、HBV-DNA与肝纤维化程度呈负相关(r=-0.220、-0.292、-0.255)。GPR、APRI、FIB-4模型的曲线下面积分别为0.714(95%CI 0.619~0.809)、0.739(95%CI 0.647~0.830)、0.718(95%CI 0.624~0.813),其临界值、敏感度、特异度分别为0.21、61.50%、74.70%,0.31、71.80%、69.10%,1.07、59.00%、82.00%。结论GPR模型对慢性乙肝患者肝纤维化程度具有一定的诊断价值,值得在临床推广应用。
Objective To evaluate the value of γ-glutamyl transpeptidase / platelet count noninvasive model (GPR) in the diagnosis of liver fibrosis in patients with chronic hepatitis B (HBV). Methods A total of 217 chronic hepatitis B patients were admitted to Ditan Hospital in Beijing from January 2009 to February 2013. According to the results of liver histopathology, 178 cases (S0 ~ S1) and significant liver Fibrosis in 39 cases (S2 ~ S4). Blood tests, serum biochemical indexes, hepatitis B virus markers and HBV-DNA were detected in the two groups respectively. Reference to the original literature to establish GPR, alanine aminotransferase / platelet count model (APRI), based on the four factors of liver fibrosis index model (FIB-4) 3 kinds of noninvasive models of predicting liver fibrosis. SPSS19.0 software was used for statistical analysis. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic ability of different noninvasive models in predicting significant hepatic fibrosis in chronic hepatitis B patients. Results APRI, FIB-4, GPR, AST, GGT, Plt, HBe Ag and HBV -DNA levels, the differences were statistically significant (P <0.05). The levels of APRI, GPR, FIB-4, AST, ALP and GGT were positively correlated with the degree of hepatic fibrosis (r = 0.317,0.285,0.290,0.259,0.188,0.238) HBV-DNA and liver fibrosis was negatively correlated (r = -0.220, -0.292, -0.255). The area under the curve of GPR, APRI and FIB-4 were 0.714 (95% CI 0.619-0.809), 0.739 (95% CI 0.647-0.830) and 0.718 (95% CI 0.624-0.813) respectively. The critical values and sensitivity , Specificity of 0.21,61.50%, 74.70%, 0.31,71.80%, 69.10%, 1.07,59.00%, 82.00% respectively. Conclusion The GPR model has certain diagnostic value for the degree of liver fibrosis in patients with chronic hepatitis B, which is worthy of clinical application.