GUCI评分在慢性HBV感染者肝纤维化无创诊断中的预测价值

陶奔; 曹雯君; 鲍腾; 郜玉峰; 叶珺; 邹桂舟

doi:10.3969/j.issn.1001-5256.2018.11.013

GUCI评分在慢性HBV感染者肝纤维化无创诊断中的预测价值

DOI: 10.3969/j.issn.1001-5256.2018.11.013

安徽医科大学第二附属医院肝病科

基金项目:

安徽省自然科学基金(1608085MH164)；

详细信息

中图分类号: R512.62;R575.2
计量
- 文章访问数: 2016
- HTML全文浏览量: 21
- PDF下载量: 324
- 被引次数: 0
出版历程
- 出版日期: 2018-11-20

Predictive value of Gteborg University Cirrhosis Index score in noninvasive diagnosis of liver fibrosis in patients with chronic hepatitis B virus infection

Research funding:

摘要

摘要:
目的与经典的APRI评分和FIB-4指数2种无创肝纤维化血清学诊断模型进行比较,探讨GUCI评分对慢性HBV感染者肝纤维化程度的预测价值。方法收集2010年1月-2016年12月在安徽医科大学第二附属医院接受肝穿刺病理学检查的慢性HBV感染者846例,分为显著肝纤维化组（≥S2期,n=396）、严重肝纤维化组（≥S3期,n=204）、肝硬化组（S4期,n=100例）; 846例患者中ALT <2×ULN 491例,其中显著肝纤维化（≥S2期） 275例、严重肝纤维化（≥S3期） 143例、肝硬化（S4期） 73例; 846例患者中HBeAg阴性383例,其中显著肝纤维化（≥S2期） 218例、严重肝纤维化（≥S3期） 110例、肝硬化（S4期） 55例。所有患者均行肝穿刺病理学检查,同时检测穿刺当天的血常规、肝功能、凝血功能等相关临床指标,根据检测的临床指标分别计算出GUCI评分、APRI评分和FIB-4指数值。符合正态分布的计量资料多组间比较采用方差分析;不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验;计数资料多组间比较采用χ2
- 肝炎,乙型,慢性 /
- 肝硬化 /
- GUCI评分 /
- 诊断
Abstract:
Objective To investigate the predictive value of G9 teborg University Cirrhosis Index ( GUCI) score in the noninvasive diagnosis of liver fibrosis stage in patients with chronic hepatitis B virus ( HBV) infection by comparing it with the classical noninvasive serological diagnosis models of aspartate aminotransferase-to-platelet ratio index ( APRI) score and fibrosis-4 ( FIB-4) index for liver fibrosis.Methods A total of 846 patients with chronic HBV infection who underwent liver biopsy in The Second Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were enrolled and divided into marked liver fibrosis ( stage ≥S2) group with 396 patients, severe liver fibrosis ( stage ≥S3) group with 204 patients, and liver cirrhosis ( stage S4) group with 100 patients. Of all 846 patients, 491 had alanine aminotransferase ( ALT) < 2 × upper limit of normal ( ULN) , among whom 275 had marked liver fibrosis ( stage ≥S2) , 143 had severe liver fibrosis ( stage ≥S3) , and 73 had liver cirrhosis ( stage S4) ; there were 383 HBeAg-negative patients, among whom 218 had marked liver fibrosis ( stage ≥S2) , 110 had severe liver fibrosis ( stage ≥S3) , and 55 had liver cirrhosis ( stage S4) . Liver biopsy was performed for all patients, and clinical indices of routine blood test, liver function, and coagulation function were measured on the same day of liver biopsy to calculate GUCI score, APRI score, and FIB-4 index. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between multiple groups; the Spearman correlation analysis was used to investigate rank correlation between three serological models and liver fibrosis stage. The receiver operating characteristic ( ROC) curve was plotted to analyze the diagnostic efficacy of three serological models for liver fibrosis, and the Z test was used for comparison of the area under the ROC curve ( AUC) . Results GUCI score, APRI score, and FIB-4 index were positively correlated with liver fibrosis stage ( r = 0. 472, 0. 435, and 0. 401, all P < 0. 001) ; aspartate aminotransferase ( AST) level and prothrombin time-international normalized ratio ( PT-INR) were positively correlated with liver fibrosis degree in patients with hepatitis B ( r = 0. 316 and 0. 401, both P < 0. 001) ; platelet count ( PLT) was negatively correlated with liver fibrosis degree in patients with hepatitis B ( r =-0. 353, P < 0. 001) . GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis ( Z = 6. 291 and3. 159, both P < 0. 001) and a higher AUC than APRI score in the diagnosis of severe liver fibrosis ( Z = 5. 306, P < 0. 0001) . In 491 patients with ALT < 2 × ULN, GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked or severe liver fibrosis ( marked liver fibrosis: Z = 5. 969 and 3. 089, both P < 0. 01; severe liver fibrosis: Z = 4. 455 and 3. 192, both P < 0. 01) . In 383 HBeAg-negative patients, GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis ( Z =5. 725 and 2. 162, both P < 0. 05) and a higher AUC than APRI score in the diagnosis of severe liver fibrosis ( Z = 4. 743, P < 0. 001) . In the patients with ALT < 2 × ULN, at the cut-off value of 0. 446, GUCI score had a sensitivity of 61. 82%, a specificity of 82. 73%, a positive predictive value of 73. 14%, and a negative predictive value of 74. 02% in the diagnosis of marked liver fibrosis ( P < 0. 001) ; at the cut-off value of 0. 492, GUCI score had a sensitivity of 76. 92%, a specificity of 72. 30%, a positive predictive value of 44. 49%, and a negative predictive value of 91. 56% in the diagnosis of severe liver fibrosis ( P < 0. 001) ; at the cut-off value of 0. 499, GUCI score had a sensitivity of 72. 00%, a specificity of 77. 90%, a positive predictive value of 29. 74%, and a negative predictive value of 95. 54% in the diagnosis of liver cirrhosis ( P < 0. 001) . Conclusion GUCI score is a simple and practical serological model for the diagnosis of liver fibrosis, especially for patients with chronic HBV infection with ALT < 2 × ULN. GUCI score has a higher value than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis and severe liver fibrosis; as for the diagnosis of liver cirrhosis, GUCI score has a similar diagnostic value as APRI score and FIB-4 index.
- hepatitis B, chronic /
- liver cirrhosis /
- GUCI score /
- diagnosis

HTML全文

参考文献(21)

[1] LUO MT, ZHENG YT. Research progress on hepatitis B virus host restriction factors[J]. Int J Virol, 2016, 23 (4) :281-284. (in Chinese) 罗梦婷, 郑永唐.乙型肝炎病毒宿主限制因子研究进展[J].国际病毒学杂志, 2016, 23 (4) :281-284.

[2] SCHMELTZER PA, TALWALKAR JA. Noninvasive tools to assess hepatic fibrosis:ready for prime time?[J]. Gastroenterol Clin North Am, 2011, 40 (3) :507-521.

[3] SHIHA G, IBRAHIM A, HELMY A, et al. Asian-pacific association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis:A 2016update[J]. Hepatol Int, 2017, 11 (1) :1-30.

[4] ISLAM S, ANTONSSON L, WESTIN J, et al. Cirrhosis in hepatitis C virus infected patients can be excluded using an index of standard biochemical serum markers[J]. Scand J Gastroenterol, 2005, 40 (7) :867-872.

[5] YOSRY A, FOUAD R, ALEM SA, et al. Fibro Scan, APRI, FIB4, and GUCI:Role in prediction of fibrosis and response to therapy in Egyptian patients with HCV infection[J]. Arab J Gastroenterol, 2016, 17 (2) :78-83.

[6] OZYALVACLI G, KUCUKBAYRAK A, KURT M, et al. Non-invasive fibrosis tests are correlated with necroinflammatory actvity of liver in patients with chronic hepatitis B[J]. Clin Ter, 2014, 165 (3) :199-204.

[7] PANG Q, ZHANG JY, XU XS, et al. The prognostic values of 12cirrhosis-relative noninvasive models in patients with hepatocellular carcinoma[J]. Scand J Clin Lab Invest, 2015, 75 (1) :73-84.

[8] CORDIE A, SALAMA A, EL-SHARKAWY M, et al. Comparing the efficiency of Fib-4, Egy-score, APRI and GUCI in liver fibrosis staging in Egyptians with chronic hepatitis C[J]. J Med Virol, 2018, 90 (6) :1106-1111.

[9] FENG L, KE S, JIE Z, et al. A novel non-invasive index using AFP and APTT is associated with liver fibrosis in patients with chronic hepatitis B infection:A retrospective cohort study[J]. BMJ Open, 2015, 5 (9) :e008032.

[10] Chinese Society of Infectious Diseases and Parasitology and Chinese Society of Hepatology of Chinese Medical Association. The program of prevention and cure for viral hepatitis[J]. Chin J Intern Med, 2001, 40 (1) :62-68. (in Chinese) 中华医学会传染病与寄生虫病学分会, 肝病学分会.病毒性肝炎防治方案[J].中华内科杂志, 2001, 40 (1) :62-68.

[11] WESTIN J, YDREBORG M, ISLAM S, et al. A non-invasive fibrosis score predicts treatment outcome in chronic hepatitis C virus infection[J]. Scand J Gastroenterol, 2008, 43 (1) :73-80.

[12] STURM N, MARLU A, ARVERS P, et al. Comparative assessment of liver fibrosis by computerized morphometry in na6ve patients with chronic hepatitis B and C[J]. Liver Int, 2013, 33 (3) :428-438.

[13] COENEN M, NISCHALKE HD, KRMER B, et al. Hepatitis C virus core protein induces fibrogenic actions of hepatic stellate cells via toll-like receptor 2[J]. Lab Invest, 2011, 91 (9) :1375-1382.

[14] BAI Q, AN J, WU X, et al. HBV promotes the proliferation of hepatic stellate cells via the PDGF-B/PDGFR-β, signaling pathway in vitro[J]. Int J Mol Med, 2012, 30 (6) :1443-1450.

[15] MA JJ, DING H, MAO F, et al. Assessment of liver fibrosis with elastography point quantification technique in chronic hepatitis B virus patients:A comparison with liver pathological results[J]. J Gastroenterol Hepatol, 2014, 29 (4) :814-819.

[16] SCHMILOVITZ-WEISS H, TOVAR A, HALPERN M, et al. Predictive value of serum globulin levels for the extent of hepatic fibrosis in patients with chronic hepatitis B infection[J]. J Viral Hepat, 2006, 13 (10) :671-677.

[17] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[18] XIAO G, YANG J, YAN L. Comparison of diagnostic accuracy of APRI and FIB-4 for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection:A systemic review and meta-analysis[J]. Hepatology, 2014, 61 (1) :292-302.

[19] KARACAER Z, ZGR AVCI, KARADA FY. King's Score may be more effective in the determination of severe fibrosis in chronic hepatitis B infections[J]. Hepatology 2017, 23 (1) :20-25.

[20] TOSON EA, SHIHA GE, EL-SAIED ESH, et al. Can Ykl-40improve the diagnostic power of non-invasive fibrogenic staging in chronic hepatitis B virus infected patients?[J]. EJPMR, 2016, 3 (11) :70-78.

[21] LI W, XU KH, ZHAO SS. Association between liver pathology and clinical features in patients with chronic HBV infection and slightly elevated alanine aminotransferase[J]. J Clic Hepatol, 2017, 33 (11) :2123-2126. (in Chinese) 李伟, 徐葵花, 赵守松. ALT轻度升高的慢性HBV感染者临床特征与病理学的关系[J].临床肝胆病杂志, 2017, 33 (11) :2123-2126.

施引文献

资源附件(0)

访问统计