PDF下载 ( 352 KB)
Value of fibrosis-4,aspartate aminotransferase-to-platelet ratio index,and globulin-platelet index in the diagnosis of significant liver fibrosis in autoimmune hepatitis
-
摘要: 目的探究肝纤维化指数（FIB-4）、天冬氨酸氨基转移酶-血小板比率指数（APRI）和球蛋白-血小板指数（GPI）三种模型对自身免疫性肝炎（AIH）显著肝纤维化的诊断价值。方法收集2011年11月-2019年5月在安徽医科大学第一附属医院住院且经肝活检确诊的47例AIH患者,以年龄与性别相匹配的47例健康人群作为对照组,依据病理结果将AIH患者分为两组:S1为轻度肝纤维化（n=16）,S2～S4为显著肝纤维化（n=31）。观察两组间年龄、血常规和生化等指标差异,计算FIB-4、APRI和GPI并进行比较分析。正态分布的计量资料两组间比较采用独立样本t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U检验。单因素分析采用二元logistic回归法,分析显著肝纤维化的影响因素;并根据受试者工作特征曲线下面积（AUC）比较各模型的诊断价值。结果与对照组相比,AIH组的Glo、ALT、AST、ALP、GGT、FIB-4、APRI和GPI水平均升高,PLT和Alb水平均降低,差异均有统计学意义（P值均<0.05）。与轻度肝纤维化相比,显著肝纤维化患者年龄、FIB-4和GPI...Abstract: Objective To investigate the value of fibrosis-4( FIB-4),aspartate aminotransferase-to-platelet ratio index( APRI),and globulin-platelet index( GPI) in the diagnosis of significant liver fibrosis in autoimmune hepatitis( AIH). Methods A total of 47 AIH patients who were hospitalized and underwent liver biopsy in The First Affiliated Hospital of Anhui Medical University from November 2011 to May 2019 were enrolled as AIH group,and 47 healthy individuals,matched for age and sex,were enrolled as control group. According to the pathological results,AIH patients were divided into mild liver fibrosis( S1) group with 16 patients and significant liver fibrosis( S2-S4) group with 31 patients. The two groups were compared in terms of age,routine blood test results,and biochemical indices,and FIB-4,APRI,and GPI were calculated and compared between the two groups. The independent samples t-test was used for comparison of normally distributed continuous data between the two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between the two groups. A univariate binary logistic regression analysis was used to investigate the risk factors for significant liver fibrosis,and the area under the receiver operating characteristic curve( AUC) was used to compare the diagnostic value of each model. Results Compared with the control group,the AIH group had significant increases in globulin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,gamma-glutamyl transpeptidase( GGT),FIB-4,APRI,and GPI and significant reductions in platelet count( PLT) and albumin( all P < 0. 05). Compared with the mild liver fibrosis group,the significant liver fibrosis group had significant increases in age( t =-2. 681,P = 0. 010),FIB-4( Z =-3. 053,P = 0. 002),and GPI( Z =-3. 457,P = 0. 001) and significant reductions in PLT( t = 3. 185,P = 0. 003) and GGT( Z =-2. 290,P = 0. 022). The univariate analysis showed that age( odds ratio[OR]= 1. 074,95% confidence interval [CI]: 1. 013-1. 139,P = 0. 017),PLT( OR = 0. 987,95% CI: 0. 978-0. 997,P = 0. 010),FIB-4( OR = 1. 339,95% CI: 1. 046-1. 713,P = 0. 021),and GPI( OR = 4. 449,95% CI: 1. 319-15. 008,P = 0. 016) were influencing factors for significant liver fibrosis in AIH patients. FIB-4 and PLT had an AUC of 0. 774 and 0. 746,respectively,in the diagnosis of significant liver fibrosis in AIH patients,and GPI had an AUC of 0. 810,a sensitivity of 83. 9%,a specificity of 81. 2%,a positive predictive value of 89. 7%,and a negative predictive value of 72. 2% in the diagnosis of significant liver fibrosis and was superior to FIB-4 and PLT. APRI had no value in the diagnosis of significant liver fibrosis in AIH patients( P = 0. 271). Conclusion GPI has a certain value in predicting significant liver fibrosis in AIH patients and thus helps to reduce the need for liver biopsy in some patients.
-
Key words:
- hepatitis,autoimmune /
- liver cirrhosis /
- diagnosis
-
[1] CZAJA AJ. Review article:The prevention and reversal of hepatic fibrosis in autoimmune hepatitis[J]. Aliment Pharmacol Ther,2014,39(4):385-406. [2] LIU XD,WU JL,LIANG J,et al. Globulin-platelet model predicts minimal fibrosis and cirrhosis in chronic hepatitis B virus infected patients[J]. World J Gastroenterol,2012,18(22):2784-2792. [3] HENNES EM,ZENIYA M,CZAJA AJ,et al. Simplified criteria for the diagnosis of autoimmune hepatitis[J]. Hepatology,2008,48(1):169-176. [4] ALVAREZ F,BERG PA,BIANCHI FB,et al. International autoimmune hepatitis group report:Review of criteria for diagnosis of autoimmune hepatitis[J]. J Hepatol,1999,31(5):929-938. [5] Chinese Society of Infectious Diseases and Parasitology,Chinese Society of Hepatology, Chinese Medical Association.Prevention and treatment of viral hepatitis[J]. Chin J Infect Dis,2001,19(1):56-62.(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]．中华传染病杂志，2001,19(1):56-62. [6] THANDASSERY RB,AL KAABI S,SOOFI ME,et al. Mean platelet volume,red cell distribution width to platelet count ratio,globulin platelet index,and 16 other indirect noninvasive fibrosis scores:How much do routine blood tests tell about liver fibrosis in chronic hepatitis C?[J]. J Clin Gastroenterol,2016,50(6):518-523. [7] LI Q,LU C,LI W,et al. Globulin-platelet model predicts significant fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase levels[J]. Clin Exp Med,2018,18(1):71-78. [8] WANG J,YAN X,YANG Y,et al. A novel predictive model using routinely clinical parameters to predict liver fibrosis in patients with chronic hepatitis B[J]. Oncotarget,2017,8(35):59257-59267. [9] WANG H,XU H,QU L,et al. Red blood cell distribution width and globulin,noninvasive indicators of fibrosis and inflammation in chronic hepatitis patients[J]. Eur J Gastroenterol Hepatol,2016,28(9):997-1002. [10] WANG H,WANG J,HUANG R,et al. Red blood cell distribution width for predicting significant liver inflammation in patients with autoimmune hepatitis[J]. Eur J Gastroenterol Hepatol,2019,31(12):1527-1532. [11] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association; Chinese Society of Infectious Diseases,Chinese Medical Association. Consensus on the diagnosis and therapy of hepatic fibrosis(2019)[J]. J Clin Hepatol,2019,35(10):2163-2172.(in Chinese)中华医学会肝病学分会，中华医学会消化病学分会，中华医学会感染病学分会．肝纤维化诊断及治疗共识(2019年)[J]．临床肝胆病杂志，2019,35(10):2163-2172. [12] ZENG T,YU J,TAN L,et al. Noninvasive indices for monitoring disease course in Chinese patients with autoimmune hepatitis[J]. Clin Chim Acta,2018,486:135-141. [13] ZHOU GQ,ZHONG QH,WANG RB,et al. Value of fibrosis-4index in diagnosis of liver fibrosis in autoimmune hepatitis[J]. J Clin Hepatol,2017,33(8):1487-1491.(in Chinese)周桂琴，钟启华，王融冰，等．FIB-4指数对自身免疫性肝炎肝纤维化的诊断价值[J]．临床肝胆病杂志，2017,33(8):1487-1491. [14] LIU L,CAO J,ZHONG Z,et al. Noninvasive indicators predict advanced liver fibrosis in autoimmune hepatitis patients[J]. J Clin Lab Anal,2019,33(7):e22922. [15] LI YQ,DONG HJ,LIU XW,et al. Latest clinical advances in autoimmune hepatitis in special populations and special types of autoimmune hepatitis[J]. J Clin Hepatol,2018,34(6):1338-1342.(in Chinese)李艳清，董洪静，刘晓雯，等．特殊人群及特殊类型自身免疫性肝炎的临床新进展[J]．临床肝胆病杂志，2018,34(6):1338-1342. [16] CHEN J,ESLICK GD,WELTMAN M. Systematic review with meta-analysis:Clinical manifestations and management of autoimmune hepatitis in the elderly[J]. Aliment Pharmacol Ther,2014,39(2):117-124. [17] ZACHOU K,GATSELIS N,PAPADAMOU G,et al. Mycophenolate for the treatment of autoimmune hepatitis:Prospective assessment of its efficacy and safety for induction and maintenance of remission in a large cohort of treatment-nave patients[J]. J Hepatol,2011,55(3):636-646. [18] LI Q,LI W,HUANG Y,et al. The gamma-glutamyl transpeptidase-to-platelet ratio predicts liver fibrosis and cirrhosis in HBe Ag-positive chronic HBV infection patients with high HBV DNA and normal or mildly elevated alanine transaminase levels in China[J]. J Viral Hepat,2016,23(11):912-919. 期刊类型引用(9)
1. 迟洵，刘思思，陈巧，胡玥，王伟仙. 不同营养筛查工具对肝硬化患者营养筛查适用性的网状Meta分析. 中国全科医学. 2025(11): 1395-1402 . 
百度学术2. 祁喜平，马蓉霞，李静，扈玫琳. 活血化瘀中医干预法对肝硬化营养不良患者的应用效果及血清营养指标影响. 中华养生保健. 2024(05): 23-26 . 百度学术3. 任婷婷，郭俊，高露露，童婉秋，王怡斌，王线妮. 降低全身型重症肌无力患者营养不良发生率. 中国卫生质量管理. 2024(04): 81-86 . 百度学术4. 迟学彭，任新华，张耀庭，张驰，陈璎珞，王琦. NRS2002与RFH-NPT营养风险筛查工具对失代偿期肝硬化住院患者的适用性. 中国肝脏病杂志(电子版). 2024(03): 65-68 . 百度学术5. 黄颖，余小平，陈怡，李云秀，刘大凤，高锦凤，韩斌，曾义岚. 失代偿期肝硬化患者营养不良诊断模型的探讨. 四川医学. 2023(02): 117-123 . 百度学术6. 杜旭芳，李超，王鹏，姚佳，杨柳青，侯慧敏. 个体化营养管理策略联合延续护理模式对肝硬化病人营养状况和生活质量的影响. 护理研究. 2023(22): 4096-4100 . 百度学术7. 付志鹏，郑盛，杨涓. 肝硬化患者营养评价方法研究进展. 国际医药卫生导报. 2023(23): 3341-3344 . 百度学术8. 陈春霞，徐冠华，崔志明. 营养评估在肝癌患者治疗中的应用研究进展. 南京医科大学学报(自然科学版). 2022(10): 1488-1494 . 百度学术9. 胡吉蕾，汤善宏，林宁. 终末期肝病合并肌肉衰减症的早期识别和营养干预. 中华临床营养杂志. 2022(05): 310-317 . 百度学术其他类型引用(4)
-
百度学术
下载:
