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目的在慢性乙型肝炎病毒(HBV)感染患者中建立基于常规实验室指标的肝纤维化非创伤性诊断模型,为传统的肝穿刺活检提供简便的非创伤性替代手段。方法采用Logistic回归等方法分析386例慢性HBV感染患者的常规实验室指标与肝纤维化分期的关系,建立诊断模型。用受试者工作曲线(ROC)等方法验证和比较该模型与Forns指数、APRI指数、Hepascore及SLFG模型的诊断价值。结果各指标组合模型对肝纤维化分期的诊断价值优于单项常规实验室指标,其中SLFG模型、S指数和Hepascore均具有较好的表现。由γ-谷氨酰转肽酶(GGT)、血小板(PLT)和白蛋白(Alb)三个常规指标组成的S指数(S指数=1000×GGT/(PLT×Alb2))判断有无明显肝纤维化和有无早期肝硬化时的受试者工作曲线下面积(AUC)分别达到0.686和0.762。使用以下推荐界值,S指数<0.1预测无明显肝纤维化的灵敏度为90.4%,S指数≥0.5预测存在明显肝纤维化的特异度为86.2%;S指数<0.3预测无早期肝硬化的灵敏度为84.8%,S指数≥1.5预测存在早期肝硬化的特异度为97.7%。结论由常规实验室指标建立的简单组合S指数,能较准确而方便地区分存在明显肝纤维化或早期肝硬化的慢性HBV感染患者。
Objective To establish a noninvasive diagnostic model of liver fibrosis based on routine laboratory tests in patients with chronic hepatitis B virus infection and provide a simple and non-invasive alternative to conventional liver biopsy. Methods Logistic regression analysis was used to analyze the relationship between routine laboratory markers and the stage of liver fibrosis in 386 patients with chronic HBV infection and to establish a diagnostic model. The receiver operating characteristic curve (ROC) was used to validate and compare the diagnostic value of the model with Forns index, APRI index, Hepascore and SLFG models. Results The diagnostic value of the combined model of each index in the staging of liver fibrosis was better than that of single routine laboratory. The SLFG model, S index and Hepascore showed good performance. The S index (S index = 1000 × GGT / (PLT × Alb2)) consisted of three conventional indicators of γ-glutamyl transpeptidase (GGT), platelet (PLT) and albumin (Alb) The area under the working curve (AUC) of subjects with fibrosis and with or without early cirrhosis reached 0.686 and 0.762, respectively. Using the following recommended cutoffs, the S-index <0.1 predicted a sensitivity of 90.4% for liver fibrosis-free and a S-index ≥0.5 for 86.2% predicted significant liver fibrosis; S-score <0.3 predicted no sensitivity for early cirrhosis Was 84.8%. The specificity of S index ≥1.5 in predicting the presence of early cirrhosis was 97.7%. Conclusion The simple combination S index established by routine laboratory indexes can distinguish the chronic HBV infection patients with obvious liver fibrosis or early liver cirrhosis more accurately and conveniently.