5种血清无创模型对慢性乙型肝炎肝纤维化分期诊断价值的比较

周新兰; 王雁冰; 陆伟; 李秀芳; 黄丹; 张占卿; 丁荣蓉

doi:10.3969/j.issn.1001-5256.2021.07.018

5种血清无创模型对慢性乙型肝炎肝纤维化分期诊断价值的比较

DOI: 10.3969/j.issn.1001-5256.2021.07.018

上海市公共卫生临床中心肝胆内科，上海 201508

基金项目:

上海市公共卫生临床中心院级基金 (KSF0576)

利益冲突证明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：周新兰、王雁冰负责课题设计，资料分析；周新兰负责撰写论文；李秀芬、黄丹、陆伟参与数据收集；张占卿、丁荣蓉负责拟定写作思路及修改论文；丁荣蓉指导撰写文章并最后定稿。

详细信息

通信作者:
丁荣荣, dingrongrong@shphc.org.cn

中图分类号: R512.62; R575.2
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出版历程
- 收稿日期: 2020-12-04
- 录用日期: 2020-12-29
- 出版日期: 2021-07-20

Value of five noninvasive serum models in the diagnosis of chronic hepatitis B liver fibrosis

Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Shanghai 201508, China

Research funding:

Shanghai Public Health Clinical Center Hospital-level Funding (KSF0576)

摘要

摘要: 目的评价AST/PLT比值指数(APRI)、纤维化评分(FIB-4)、GGT与PLT比值(GPR)、哥德堡大学肝硬化指数(GUCI)评分和King's评分对慢性乙型肝炎(CHB)患者肝纤维化分期的诊断价值。方法选取2016年1月—2018年12月于上海市公共卫生临床中心肝胆内科住院期间接受肝组织活检及常规实验室检查的CHB患者612例。依据Scheuer方法进行炎症分级(G)和纤维化分期(S)，并依据临床指标分别计算APRI、FIB-4、GPR、GUCI评分和King's评分。符合正态分布的计量资料两组间比较采用t检验，非正态分布计量资料两组间比较采用Mann-Whitney U检验；计数资料两组间比较采用χ²检验。两变量间相关性应用Spearman相关分析。采用受试者工作特征曲线下面积(AUC)比较诊断性能。结果 GPR、APRI、FIB-4、King's评分和GUCI评分在S1~2与S3~4组间比较差异均有统计学意义(Z值分别为8.683、7.372、6.294、7.204和7.795，P值均＜0.001)。GPR、APRI、FIB-4、King's评分和GUCI评分与肝纤维化分期均呈正相关(r值分别是0.54、0.48、0.44、0.48、0.49，P值均＜0.001)。GPR诊断≥S2、≥S3和S4的AUC分别为0.76、0.80和0.82；APRI诊断≥S2、≥S3和S4的AUC分别为0.75、0.75和0.74；FIB-4诊断≥S2、≥S3和S4的AUC分别为0.70、0.75和0.78；King's评分诊断≥S2、≥S3和S4的AUC分别为0.74、0.76和0.77；GUCI评分诊断≥S2、≥S3和S4的AUC分别为0.75、0.76和0.76。结论相较于APRI、FIB-4、GUCI评分和King's评分，GPR对CHB肝纤维化分期的诊断效能最佳。
- 乙型肝炎, 慢性 /
- 肝硬化 /
- 诊断
Abstract: Objective To investigate the value of aspartate aminotransferase-to-platelet count ratio index (APRI), fibrosis-4 (FIB-4) score, gamma-glutamyl transpeptidase-to-platelet ratio (GPR), Göteborg University Cirrhosis Index (GUCI) score, and King's score in assessing liver fibrosis stage in patients with chronic hepatitis B (CHB). Methods A total of 612 patients with CHB who were hospitalized in Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, from January 2016 to December 2018 and underwent liver biopsy and routine laboratory examinations were enrolled. The Scheuer method was used to determine inflammation grade (G) and fibrosis stage (S), and related clinical indicators were used to calculate APRI, FIB-4, GPR, GUCI score, and King's score. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was used to investigate the correlation between two variables, and the area under the ROC curve (AUC) was used to compare diagnostic performance. Results There were significant differences in GPR, APRI, FIB-4, King's score, and GUCI score between the patients with S1-S2 fibrosis and those with S3-S4 fibrosis (Z=8.683, 7.372, 6.294, 7.204, and 7.795, all P < 0.001). GPR, APRI, FIB-4, King's score, and GUCI score were all positively correlated with liver fibrosis stage (r=0.54, 0.48, 0.44, 0.48, and 0.49, all P < 0.001). In the diagnosis of ≥S2, ≥S3, and S4 liver fibrosis, GPR had AUCs of 0.76, 0.80, and 0.82, respectively; APRI had AUCs of 0.75, 0.75, and 0.74, respectively; FIB-4 had AUCs of 0.70, 0.75 and 0.78, respectively; King's score had AUCs of 0.74, 0.76, and 0.77, respectively; GUCI had AUCs of 0.75, 0.76, and 0.76, respectively. Conclusion Among these five noninvasive models, GPR has the best diagnostic performance in determining liver fibrosis stage in patients with CHB.
- Hepatitis B, Chronic /
- Liver Cirrhosis /
- Diagnosis

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表 1 纳入CHB患者的临床资料

指标	所有患者(n=612)	S1~2(n=405)	S3~4(n=207)	统计值	P值
男性[例(%)]	402 (65.7)	257 (63.5)	145 (70.0)	χ²=2.641	0.104
年龄(岁)	37(31~46)	38(31~45)	37(31~46)	Z=-0.694	0.488
HBeAg阳性[例(%)]	333 (54.4)	203(50.1)	130 (62.8)	χ²=8.877	0.003
ALT(U/L)	60 (30~142)	52 (25~126)	78 (39~180)	Z=4.027	＜0.001
AST(U/L)	42 (25~89)	34 (22~70)	59(36~114)	Z=4.656	＜0.001
TBil(μmol/L)	13.8 (9.8~19.6)	12.4(9.2~17.2)	17.3(11.3~27.5)	Z=4.426	＜0.001
GGT(U/L)	37(20~83)	28 (17~52)	68(36~117)	Z=6.880	＜0.001
Alb(g/L)	42.0(39.3~44.5)	42.6(40.3~45.3)	40.1(37.5~43.4)	Z=-4.438	＜0.001
血小板计数(×10⁹/L)	156.00±56.80	172.39±52.08	124.86±52.36	t=-8.011	＜0.001
GPR	0.51 (0.25~1.24)	0.35 (0.19~0.67)	1.13 (0.58~2.28)	Z=8.683	＜0.001
APRI	0.78 (0.39~1.67)	0.55 (0.33~1.12)	1.39 (0.81~2.78)	Z=7.372	＜0.001
FIB-4	1.39 (0.92~2.42)	1.19 (0.81~1.76)	2.34 (1.34~4.31)	Z=6.294	＜0.001
King's评分	11.78(6.21~26.26)	8.57(5.12~17.32)	24.96(11.51~54.56)	Z=7.204	＜0.001
GUCI评分	0.83(0.41~1.85)	0.57(0.35~1.21)	1.51(0.87~3.28)	Z=7.795	＜0.001

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表 2 5种无创模型诊断肝纤维化分期的效能分析

诊断模型	≥S2			≥S3			S4
诊断模型	AUC	95%CI	P值	AUC	95%CI	P值	AUC	95%CI	P值
GPR	0.76	0.73~0.78	＜0.001	0.80	0.77~0.82	＜0.001	0.82	0.80~0.84	＜0.001
APRI	0.75	0.73~0.78	＜0.001	0.75	0.72~0.77	＜0.001	0.74	0.71~0.77	＜0.001
FIB-4	0.70	0.67~0.73	＜0.001	0.75	0.72~0.77	＜0.001	0.78	0.75~0.80	＜0.001
King's评分	0.74	0.71~0.76	＜0.001	0.76	0.73~0.78	＜0.001	0.77	0.74~0.80	＜0.001
GUCI评分	0.75	0.72~0.77	＜0.001	0.76	0.73~0.78	＜0.001	0.76	0.73~0.78	＜0.001

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表 3 5种无创模型诊断肝纤维化分期的临床价值

诊断模型	截断值	敏感度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)	阳性似然比	阴性似然比	准确度(%)
≥S2
GPR	0.49	66.81	75.62	82.6	56.9	2.74	0.44	70.03
APRI	0.76	64.96	74.63	81.6	55.2	2.55	0.47	68.50
FIB-4	1.48	57.91	71.96	77.9	50.0	2.07	0.58	63.09
King's评分	12.09	61.56	73.03	80.1	51.9	2.28	0.53	65.71
GUCI评分	0.68	72.10	66.57	79.3	57.3	2.16	0.42	70.11
≥S3
GPR	0.54	79.06	68.46	56.9	86.1	2.51	0.31	72.10
APRI	0.80	76.70	65.15	53.7	84.2	2.20	0.36	69.04
FIB-4	1.67	65.15	72.74	55.4	80.1	2.39	0.48	70.14
King's评分	14.04	69.44	69.66	54.4	81.4	2.29	0.44	69.58
GUCI评分	0.83	76.74	64.01	52.9	83.9	2.13	0.36	68.40
S4
GPR	0.72	77.83	84.14	43.2	92.7	3.78	0.30	79.21
APRI	0.85	79.57	62.87	36.0	92.2	2.14	0.33	66.33
FIB-4	2.44	59.51	73.23	49.1	84.2	2.91	0.48	74.20
King's评分	15.25	77.72	65.04	36.5	91.9	2.22	0.34	67.54
GUCI评分	0.88	80.86	61.04	35.5	92.3	2.08	0.31	65.20

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