肝硬化是各种慢性肝病导致肝脏弥漫性纤维化、再生结节形成的病理阶段[1]，我国由HBV所致的肝硬化约为77%[2]，患者处于代偿期时可无特异性症状和体征，起病常隐匿[1]，而一旦进入有明显症状如腹水、肝性脑病等失代偿期，5年生存率仅为14%~35%[3]。相关指南、共识意见[1-2, 4-5]及研究[6-9]显示了肝硬化无创诊断方法如肝纤维化4因子指数(fibrosis 4 score，FIB-4)、AST和PLT比值指数(APRI)、GGT-PLT比值(GPR)、红细胞体积分布宽度(RDW)-PLT比值(red cell distribution width to platelet ratio，RPR)、肝脏瞬时弹性成像技术(TE)对肝硬化有着良好的诊断效应，但关于中医辨证分型与无创诊断方法的相关性分析较少，特别是在患者处于代偿期时临床症状轻，甚至“无症可辨”，这就给中医辨病、辨证论治造成一定的困难。近数十年的临床研究[4, 10]已经表明中医药在肝硬化防治领域具有疗效优势，且尚未有不良反应的报道。因此，寻找一种客观化指标辅助中医的诊治有着重要的意义。不但为中医辨证分型提供量化指标，使分型不仅结合病机更注重疾病所处阶段；而且中西医相结合，进一步准确客观的评估中医辨证论治的临床疗效。本研究通过回顾性分析代偿期乙型肝炎肝硬化患者相关临床资料，探讨以上5种肝硬化无创诊断方法在代偿期乙型肝炎肝硬化中与中医证型的关系，以期提高临床诊断辨证的准确性。
回顾性纳入河南中医药大学第一附属医院2017年1月—2020年1月期间门诊和住院的代偿期乙型肝炎肝硬化患者共327例。
(1) 西医诊断标准：参照《慢性乙型肝炎防治指南(2019年版)》[2]、《肝硬化诊治指南(2019年版)》[1]。(2)中医辨病辨证标准: ①诊断标准，参照《肝纤维化中西医结合诊疗指南(2019年版)》[4]与《肝硬化中西医结合诊疗共识(2011年版)》[5]分为肝郁脾虚证、肝胆湿热证、肝肾阴虚证、脾肾阳虚证、瘀血阻络证5型；②中医辨证分型，由1名主任医师和2名具有执业医师资格证的医师进行辨证并意见一致。
(1) 符合代偿期乙型肝炎肝硬化西医诊断标准；(2)相关检验检查资料完整无缺失；(3)年龄18~75岁。
(1) 其他类型的肝硬化(丙型肝炎肝硬化、自身免疫性肝炎肝硬化、酒精性肝硬化等)及合并此类疾病；(2)肝硬化失代偿期；(3)合并肝癌、其他恶性肿瘤。
采用本研究小组制定的《肝硬化患者信息采集表》采集信息，使用EpiData3.1软件进行采集，并采用双人进行数据同步录入、核对、管理与质量控制。采集信息包括：(1)患者一般资料：姓名、性别、年龄等；(2)检验检查结果：PLT、RDW、ALT、AST、Alb、血清球蛋白(Glb)、GGT、FibroScan肝脏硬度值(LSM值)、彩超(具体报告及门静脉主干宽度等)。以上实验室指标均来自河南中医药大学第一附属医院检验科，LSM值来自河南中医药大学第一附属医院肝病实验室，彩超结果来自河南中医药大学第一附属医院超声科。肝纤维化无创诊断计算公式：(1)APRI=AST/AST正常值上限/PLT×100；(2)FIB-4=年龄×AST/(PLT×ALT的平根)；(3)GPR=GGT/GGT正常值上限/PLT×100；(4)RPR=RDW/PLT。
本研究通过河南中医药大学第一附属医院临床伦理委员会批准，批号: 2021HL-113-01。
采用SPSS 21.0统计软件进行数据分析。所有的统计检验均采用双侧检验，符合正态分布的计量资料以x±s表示，多组间均数比较用单因素方差分析，进一步两两比较采用LSD-t检验；不符合正态分布的计量资料采用M(P25~P75)表示，多组间比较用多个独立样本Kruskal-Wallis H秩和检验，采用Kruskal-Wallis单因素ANOVE(k样本)进行多重比较；采用二元logistic回归分析进行中医证型与肝硬化无创诊断的关系；应用ROC曲线评价各无创诊断在中医证型中的价值。采用MedCalc 15.2.2软件计算各证型无创诊断的AUC、临界值、敏感度、特异度、阳性预测值、阴性预测值、似然比。P＜0.05为差异有统计学意义。
本研究共收集病历327例，其中男238例，女89例，年龄最小20岁，最大75岁，平均(44.14±11.26)岁, 各证型间性别与年龄分布差异无统计学意义(P值均＞0.05)(表 1)。在代偿期乙型肝炎肝硬化患者中，主要的中医证型为肝郁脾虚证、肝胆湿热证、瘀血阻络证。
| 证型 | 例数 | 性别 | 年龄（岁） | |
| 男(例) | 女(例) | |||
| 肝郁脾虚证 | 160 | 120 | 40 | 42.96±10.74 |
| 肝胆湿热证 | 84 | 60 | 24 | 43.17±11.12 |
| 肝肾阴虚证 | 13 | 8 | 5 | 45.46±10.41 |
| 脾肾阳虚证 | 5 | 4 | 1 | 46.60±9.74 |
| 瘀血阻络证 | 65 | 46 | 19 | 47.80±10.92 |
| 统计值 | χ2=1.569 | F=2.451 | ||
| P值 | 0.814 | 0.056 | ||
主要中医证型的检验检查资料除Glb以外，差异均具有统计学意义(P＜0.05)，进一步两两比较，发现瘀血阻络证PLT、Alb降低最为明显，门静脉宽度升高均最为明显；肝胆湿热证ALT、AST升高最为明显；在5种无创诊断方法中，除APRI外，瘀血阻络证升高均最为明显(P值均＜0.05)(表 2)。
| 相关指标 | 肝郁脾虚证(n=160) | 肝胆湿热证(n=84) | 瘀血阻络证(n=65) | 统计量 | P值 |
| PLT(×109/L) | 138.00(85.25~177.25) | 110.50(92.25~142.75) | 44.00(34.00~55.50)1)2) | χ2=155.337 | ＜0.05 |
| ALT(U/L) | 34.00(21.95~43.63) | 68.85(48.75~109.43)1) | 29.50(17.95~39.75)2) | χ2=123.210 | ＜0.05 |
| AST(U/L) | 28.95(23.60~39.63) | 61.40(40.15~94.03)1) | 27.60(21.55~38.05)2) | χ2=86.659 | ＜0.05 |
| Alb(g/L) | 44.97±3.13 | 46.25±3.331) | 31.41±2.461)2) | F=542.512 | ＜0.05 |
| GLB(g/L) | 29.04±4.46 | 28.76±4.71 | 29.09±4.62 | F=0.128 | 0.88 |
| GGT(U/L) | 31.20(20.83~53.13) | 39.10(27.33~65.15)1) | 27.70(21.70~44.05)2) | χ2=13.079 | ＜0.05 |
| 门静脉主干宽度(mm) | 12.79±0.76 | 12.18±0.991) | 13.40±0.581)2) | F=43.373 | ＜0.05 |
| LSM值(kPa) | 16.00(13.40~18.08) | 18.65(16.63~25.00)1) | 24.40(22.30~26.50)1)2) | χ2=131.312 | ＜0.05 |
| APRI | 1.10(0.62~1.35) | 1.30(0.88~2.00)1) | 1.55(1.26~2.31)1) | χ2=54.280 | ＜0.05 |
| FIB-4 | 1.90(1.38~2.74) | 2.66(1.99~3.54)1) | 6.19(4.66~8.37)1)2) | χ2=129.893 | ＜0.05 |
| GPR | 0.67(0.27~1.18) | 0.81(0.49~1.27)1) | 1.52(0.94~2.46)1)2) | χ2=57.485 | ＜0.05 |
| RPR | 0.37±0.16 | 0.39±0.10 | 1.10±0.341)2) | F=351.219 | ＜0.05 |
| 注：与肝郁脾虚证相比，1)P＜0.05；与肝胆湿热证相比, 2)P＜0.05。 | |||||
在肝胆湿热证中，AST(OR=1.981，95%CI：1.8225~2.139，P＜0.05)、LSM(OR=2.002，95%CI：1.840~2.160，P＜0.05)是代偿期乙型肝炎肝硬化的影响因素；在肝郁脾虚证中，门静脉宽度(OR=4.402，95%CI：4.050~4.754，P＜0.05)、LSM值(OR=3.901，95%CI：3.589~4.213，P＜0.05)、APRI(OR=1.891，95%CI：1.740~2.042，P＜0.05)、FIB-4(OR=1.845，95%CI：1.697~1.993，P＜0.05)是代偿期乙型肝炎肝硬化的影响因素；在瘀血阻络证中，LSM值(OR=2.465，95%CI：2.268~2.662, P＜0.05)、APRI(OR=1.298，95%CI：1.194~1.402, P＜0.05)、FIB-4(OR=1.849，95%CI：1.701~1.997, P＜0.05)是代偿期乙型肝炎肝硬化的影响因素。
5种无创诊断方法在诊断肝郁脾虚证中的ROC曲线见图 1，临界值(cut-off值)、敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比见表 3，由图表可知，在代偿期乙型肝炎肝硬化患者中，LSM值与FIB-4模型评估肝郁脾虚证的诊断价值明显优于其他诊断方法。
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.982(0.955~0.995) | 0.875 | 98.12 | 89.33 | 95.2 | 95.7 | 9.20 | 0.02 |
| APRI | 0.899(0.853~0.934) | 0.629 | 86.87 | 76.00 | 88.5 | 73.1 | 3.62 | 0.17 |
| FIB-4 | 0.950(0.913~0.974) | 0.776 | 85.62 | 92.00 | 95.8 | 75.0 | 10.70 | 0.16 |
| GPR | 0.618(0.553~0.680) | 0.303 | 55.63 | 74.67 | 82.4 | 44.1 | 2.20 | 0.59 |
| RPR | 0.752(0.692~0.806) | 0.533 | 61.25 | 92.00 | 94.2 | 52.7 | 7.66 | 0.42 |
5种无创诊断方法在诊断肝胆湿热证中的ROC曲线见图 2，cut-off值、敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比见表 4，由图表可知，在代偿期乙型肝炎肝硬化患者中，LSM值与RPR模型评估肝胆湿热证的诊断价值明显优于其他诊断方法。
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.922(0.868~0.958) | 0.806 | 95.24 | 85.33 | 87.9 | 94.1 | 6.49 | 0.06 |
| APRI | 0.834(0.767~0.888) | 0.570 | 80.95 | 76.00 | 79.1 | 78.1 | 3.37 | 0.25 |
| FIB-4 | 0.848(0.783~0.900) | 0.536 | 86.90 | 66.67 | 74.5 | 82.0 | 2.61 | 2.61 |
| GPR | 0.844(0.778~0.896) | 0.553 | 72.62 | 82.67 | 82.4 | 72.9 | 4.19 | 0.33 |
| RPR | 0.958(0.914~0.983) | 0.777 | 85.71 | 92.00 | 92.3 | 85.2 | 10.71 | 0.16 |
5种无创诊断方法在诊断瘀血阻络证中的ROC曲线见图 3，cut-off值、敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比见表 5，由图表可知，在代偿期乙型肝炎肝硬化患者中，5种无创诊断方法均能较好地评估瘀血阻络证。
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.969(0.925~0.991) | 0.893 | 100.00 | 89.33 | 89.0 | 100.0 | 9.37 | 0.00 |
| APRI | 0.895(0.831~0.940) | 0.731 | 98.46 | 74.67 | 77.1 | 98.2 | 3.89 | 0.02 |
| FIB-4 | 0.949(0.899~0.979) | 0.845 | 93.85 | 90.67 | 89.7 | 94.4 | 10.05 | 0.07 |
| GPR | 0.941(0.888~0.973) | 0.765 | 93.85 | 82.67 | 82.4 | 93.9 | 5.41 | 0.07 |
| RPR | 0.935(0.880~0.969) | 0.893 | 100.00 | 89.33 | 89.0 | 100.0 | 9.37 | 0.00 |
本研究对327例代偿期乙型肝炎肝硬化患者进行中医证候分析，发现以肝郁脾虚证、肝胆湿热证、瘀血阻络证最为常见，且肝郁脾虚证患者明显高于其他证型，同时发现5种肝硬化无创诊断方法在证型之间的差异均具有统计学意义(P＜0.05)，且数值均在瘀血阻络证中最高，而后依次为肝胆湿热证、肝郁脾虚证，这与既往的研究结果具有一致性[11]。结果说明在代偿期乙型肝炎肝硬化中不同证型其肝硬化程度不同，这与本病的中医病机演变规律相同。本病的形成多是由于HBV湿热疫毒之邪外侵袭人体，阻滞肝经，肝失疏泄，又湿邪最易伤脾，脾气虚弱，木郁犯土，发为本病；脾失健运，水湿内停，脾虚湿盛，邪正相争，湿郁化热，病情加重；湿滞血行不畅，瘀血阻滞经络，气病及血，瘀血阻滞经络，疾病进一步发展。故代偿期乙型肝炎肝硬化病位以肝、脾为主，病性以气滞、脾虚、湿热、血瘀为主，本病初始病理状态为肝郁、脾虚，湿热为病情发展的病理过程，瘀血为代偿期即将向失代偿期发展的关键病理因素。同时发现肝胆湿热证ALT、AST升高最为明显，肝胆湿热证尚属于本病的早中期，此期邪盛而正未虚，为疾病的进展期，大量的ALT、AST由肝细胞释放入血，导致ALT、AST明显高于其他证型，同时logistic回归分析显示，AST为肝胆湿热证的影响因素。而在瘀血阻络证中门静脉宽度明显高于其他证型，Alb、PLT较其他证型降低。在病变尚处于初期的肝郁脾虚证时，患者的肝脏尚可合成人体所需的蛋白，营养状态尚可；随着病情逐渐发展，气病及血，此时患者血中Alb水平则降低，患者营养状态较差；另一方面，长期的瘀血导致脾充血性肿大，门静脉宽度随之增宽，大量的正常细胞在脾脏被破坏，造成PLT的下降[12]。
乙型肝炎肝硬化发病率高，然而作为“金标准”的肝脏病理学检查因样本取材偏差、肝脏穿刺组织易碎、患者不宜接受有创操作等原因，在临床中往往受到一定程度的制约[13]，而肝硬化无创诊断可以在一定程度上弥补病理学检查的不足之处[2, 14]。《慢性乙型肝炎防治指南(2019年版)》[2]指出，在评估HBV相关肝纤维化方面，FIB-4对于慢性乙型肝炎及乙型肝炎肝硬化的鉴别参考价值优于APRI，在代偿期与失代偿肝硬化鉴别过程中APRI及FIB-4指数具有参考价值[15-16]。有研究[17]发现，GPR模型在诊断明显肝纤维化和肝硬化方面的价值要高于APRI、FIB-4模型。RPR模型是基于乙型肝炎建立的诊断肝硬化的无创模型，可作为临床诊断及检测乙型肝炎肝硬化的有力补充，丁予昀等[18]认为，RDW及PLT是影响肝硬化程度的独立危险因素。《无创伤检查评估肝脏疾病严重程度及预后临床指南(2015年版)》[19]中指出：TE可作为低风险患者判定是否出现严重肝纤维化或肝硬化的首选方法。本研究发现，APRI与FIB-4在评估肝胆湿热证时的诊断价值明显低于其他方法，而LSM值与RPR模型高于其他方法，这可能与APRI、FIB-4模型里均有转氨酶有关，在肝胆湿热证时ALT、AST明显高于其他证型，而患者在此时常常会应用保肝降酶药物，从而导致转氨酶发生变化，以致APRI、FIB-4模型评估存在误差；而当患者处于肝硬化初期肝郁脾虚证时，患者肝功能一般无明显异常，故APRI、FIB-4模型在评估肝郁脾虚证的诊断价值较好，这与既往研究[12, 20-21]的结果类似；而5种无创诊断方法均能较好地评估瘀血阻络证，这可能和瘀血阻络证处于代偿期乙型肝炎肝硬化后期，患者持续保持肝硬化状态，肝硬化程度进一步严重，影响评分的血常规、肝功能等情况较为稳定。最后，本研究还发现LSM值对三个主要中医证型均有很好的诊断价值(P值均＜0.05)，对于其他无创诊断方法明显占据优势，这可能与TE结果受转氨酶、肝功能的影响较小有关[20]，这与既往的研究[22-23]结果类似。
综上所述，5种肝硬化无创诊断方法在评估代偿期乙型肝炎肝硬化不同中医证型有一定的诊断参考价值：TE技术在乙型肝炎肝硬化代偿期时有很好的诊断价值，肝郁脾虚证时，LSM值与FIB-4模型明显优于其他诊断方法，LSM值与RPR模型评估肝胆湿热证时占优势，5种无创诊断方法均能较好地评估瘀血阻络证。虽然在当前条件下无创诊断方法不能完全替代肝活检，不过在今后，非侵入性肝纤维化检测技术将成为诊断肝纤维化的主要研究方向[24]，在接下来的研究中可进行大样本、多重资料的验证，同时结合长期的临床试验，利用肝硬化无创诊断方法联合与中医证型间差异性明显的指标，以期提高中医临床诊断辨证的准确性。
| [1] |
BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. DOI: 10.3322/caac.21492.
|
| [2] |
ZHOU M, WANG H, ZENG X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204): 1145-1158. DOI: 10.1016/S0140-6736(19)30427-1.
|
| [3] |
CHEN W, ZHENG R, BAADE PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132. DOI: 10.3322/caac.21338.
|
| [4] |
General Office of National Health Commission. Standard for diagnosis and treatment of primary liver cancer (2022 edition)[J]. J Clin Hepatol, 2022, 38(2): 288-303. DOI: 10.3969/j.issn.1001-5256.2022.02.009.
国家卫生健康委办公厅. 原发性肝癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38(2): 288-303. DOI: 10.3969/j.issn.1001-5256.2022.02.009.
|
| [5] |
XU XF, XING H, HAN J, et al. Risk factors, patterns, and outcomes of late recurrence after liver resection for hepatocellular carcinoma: a multicenter study from China[J]. JAMA Surg, 2019, 154(3): 209-217. DOI: 10.1001/jamasurg.2018.4334.
|
| [6] |
DHIR M, MELIN AA, DOUAIHER J, et al. A review and update of treatment options and controversies in the management of hepatocellular carcinoma[J]. Ann Surg, 2016, 263(6): 1112-1125. DOI: 10.1097/SLA.0000000000001556.
|
| [7] |
AMISAKI M, SAITO H, TOKUYASU N, et al. Prognostic value of postoperative complication for early recurrence after curative resection of hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(4): 323-329. DOI: 10.1016/j.hbpd.2018.03.016.
|
| [8] |
YANG T, ZHANG J, LU JH, et al. Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases[J]. World J Surg, 2011, 35(9): 2073-2082. DOI: 10.1007/s00268-011-1161-0.
|
| [9] |
CHOK KS, NG KK, POON RT, et al. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma[J]. Br J Surg, 2009, 96(1): 81-87. DOI: 10.1002/bjs.6358.
|
| [10] |
HARIMOTO N, SHIRABE K, IKEGAMI T, et al. Postoperative complications are predictive of poor prognosis in hepatocellular carcinoma[J]. J Surg Res, 2015, 199(2): 470-477. DOI: 10.1016/j.jss.2015.06.012.
|
| [11] |
THELEN A, BENCKERT C, TAUTENHAHN HM, et al. Liver resection for hepatocellular carcinoma in patients without cirrhosis[J]. Br J Surg, 2013, 100(1): 130-137. DOI: 10.1002/bjs.8962.
|
| [12] |
LI Y, WANG JS, GUO Y, et al. Use of the alkaline phosphatase to prealbumin ratio as an independent predictive factor for the prognosis of gastric cancer[J]. World J Gastroenterol, 2020, 26(44): 6963-6978. DOI: 10.3748/wjg.v26.i44.6963.
|
| [13] |
RAHBARI NN, GARDEN OJ, PADBURY R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS)[J]. Surgery, 2011, 149(5): 713-724. DOI: 10.1016/j.surg.2010.10.001.
|
| [14] |
DINDO D, DEMARTINES N, CLAVIEN PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2): 205-213. DOI: 10.1097/01.sla.0000133083.54934.ae.
|
| [15] |
CLAVIEN PA, BARKUN J, de OLIVEIRA ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience[J]. Ann Surg, 2009, 250(2): 187-196. DOI: 10.1097/SLA.0b013e3181b13ca2.
|
| [16] |
HAARHAUS M, BRANDENBURG V, KALANTAR-ZADEH K, et al. Alkaline phosphatase: a novel treatment target for cardiovascular disease in CKD[J]. Nat Rev Nephrol, 2017, 13(7): 429-442. DOI: 10.1038/nrneph.2017.60.
|
| [17] |
PARK JB, KANG DY, YANG HM, et al. Serum alkaline phosphatase is a predictor of mortality, myocardial infarction, or stent thrombosis after implantation of coronary drug- eluting stent[J]. Eur Heart J, 2013, 34(12): 920-931. DOI: 10.1093/eurheartj/ehs419.
|
| [18] |
LI JP, XU T, YANG FC, et al. Prognostic value of APAR for patients with hepatocellular carcinoma after radical hepatectomy[J/CD]. Chin J Hepat Surg(Electronic Edition), 2021, 10(3): 279-284. DOI: 10.3877/cma.j.issn.2095-3232.2021.03.010.
李蒋鹏, 徐婷, 杨发才, 等. APAR对肝细胞癌根治性切除术后患者预后的预测价值[J/CD]. 中华肝脏外科手术学电子杂志, 2021, 10(3): 279-284. DOI: 10.3877/cma.j.issn.2095-3232.2021.03.010.
|
| [19] |
BARGER A, BAKER K, DRISKELL E, et al. The use of alkaline phosphatase and runx2 to distinguish osteosarcoma from other common malignant primary bone tumors in dogs[J]. Vet Pathol, 2022, 59(3): 427-432. DOI: 10.1177/03009858221083035.
|
| [20] |
YANG Y, ZHANG M, ZHANG W, et al. Sensitive sensing of alkaline phosphatase and γ-glutamyltranspeptidase activity for tumor imaging[J]. Analyst, 2022, 147(8): 1544-1550. DOI: 10.1039/d2an00163b.
|
| [21] |
XIA F, NDHLOVU E, LIU Z, et al. Alpha-fetoprotein+alkaline phosphatase (A-A) score can predict the prognosis of patients with ruptured hepatocellular carcinoma underwent hepatectomy[J]. Dis Markers, 2022, 2022: 9934189. DOI: 10.1155/2022/9934189.
|
| [22] |
ZHANG K, DONG S, JING YH, et al. Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis[J]. BMC Cancer, 2020, 20(1): 541. DOI: 10.1186/s12885-020-07023-9.
|
| [23] |
ZHOU S, JIANG W, WANG H, et al. Predictive value of pretreatment albumin-to-alkaline phosphatase ratio for overall survival for patients with advanced non-small cell lung cancer[J]. Cancer Med, 2020, 9(17): 6268-6280. DOI: 10.1002/cam4.3244.
|
| [24] |
CHEN XY, LAN M, ZHOU Y, et al. Risk factors for bone metastasis from renal cell cancer[J]. J Bone Oncol, 2017, 9: 29-33. DOI: 10.1016/j.jbo.2017.10.004.
|
| [25] |
SMITH SH. Using albumin and prealbumin to assess nutritional status[J]. Nursing, 2017, 47(4): 65-66. DOI: 10.1097/01.NURSE.0000511805.83334.df.
|
| [26] |
DELLIÈRE S, CYNOBER L. Is transthyretin a good marker of nutritional status?[J]. Clin Nutr, 2017, 36(2): 364-370. DOI: 10.1016/j.clnu.2016.06.004.
|
| [27] |
BECK FK, ROSENTHAL TC. Prealbumin: a marker for nutritional evaluation[J]. Am Fam Physician, 2002, 65(8): 1575-1578.
|
| [28] |
SHEN Z, ZHANG J, ZHAO S, et al. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: A retrospective and propensity score- matched analysis[J]. Pancreatology, 2020, 20(3): 529-536. DOI: 10.1016/j.pan.2020.02.002.
|
| [29] |
LOFTUS TJ, BROWN MP, SLISH JH, et al. Serum levels of prealbumin and albumin for preoperative risk stratification[J]. Nutr Clin Pract, 2019, 34(3): 340-348. DOI: 10.1002/ncp.10271.
|
| [30] |
HUANG L, LI J, YAN JJ, et al. Prealbumin is predictive for postoperative liver insufficiency in patients undergoing liver resection[J]. World J Gastroenterol, 2012, 18(47): 7021-7025. DOI: 10.3748/wjg.v18.i47.7021.
|
| [31] |
LI JD, XU XF, HAN J, et al. Preoperative prealbumin level as an independent predictor of long-term prognosis after liver resection for hepatocellular carcinoma: a multi-institutional study[J]. HPB (Oxford), 2019, 21(2): 157-166. DOI: 10.1016/j.hpb.2018.06.1803.
|
| [32] |
CHRYSOSTOMOU S, STATHAKIS C, PETRIKKOS G, et al. Assessment of prealbumin in hemodialysis and renal-transplant patients[J]. J Ren Nutr, 2010, 20(1): 44-51. DOI: 10.1053/j.jrn.2009.04.001.
|
| [33] |
LIU F, CAI LY, ZHONG L, et al. Model for end-stage liver disease combined with serum prealbumin to predict the prognosis of patients with decompensated liver cirrhosis[J]. J Dig Dis, 2010, 11(6): 352-357. DOI: 10.1111/j.1751-2980.2010.00465.x.
|
| [34] |
ROCHE M, LAW TY, KUROWICKI J, et al. Albumin, prealbumin, and transferrin may be predictive of wound complications following total knee arthroplasty[J]. J Knee Surg, 2018, 31(10): 946-951. DOI: 10.1055/s-0038-1672122.
|
| [35] |
KALANTAR-ZADEH K, ANKER SD, HORWICH TB, et al. Nutritional and anti-inflammatory interventions in chronic heart failure[J]. Am J Cardiol, 2008, 101(11A): 89E-103E. DOI: 10.1016/j.amjcard.2008.03.007.
|
| [36] |
WEN X, YAO M, LU Y, et al. Integration of prealbumin into Child-Pugh classification improves prognosis predicting accuracy in HCC patients considering curative surgery[J]. J Clin Transl Hepatol, 2018, 6(4): 377-384. DOI: 10.14218/JCTH.2018.00004.
|
| [37] |
JIA RR, ZHONG JH, HUO RR, et al. Correlation between serum prealbumin and prognosis of patients with hepatocellular carcinoma after hepatectomy[J]. J Surg Oncol, 2019, 119(6): 794-800. DOI: 10.1002/jso.25378.
|
| [38] |
LI CX, ZHANG H, WU XF, et al. Clinical efficacy and prognostic factors analysis following curative hepatectomy for hepatocellular carcinoma patients with different China Liver Cancer Staging[J]. Chin J Surg, 2021, 59(2): 134-143. DOI: 10.3760/cma.j.cn112139-20200803-00605.
李长贤, 张慧, 吴晓峰, 等. 不同中国肝癌分期肝癌根治性切除术后的临床效果及预后因素分析[J]. 中华外科杂志, 2021, 59(2): 134-143. DOI: 10.3760/cma.j.cn112139-20200803-00605.
|
| [39] |
KIM JH, KIM JW, SEO JW, et al. Noninvasive tests for fibrosis predict 5-year mortality and hepatocellular carcinoma in patients with chronic hepatitis B[J]. J Clin Gastroenterol, 2016, 50(10): 882-888. DOI: 10.1097/MCG.0000000000000574.
|
| [1] | Decai KONG, Xiaojing ZHANG, Yangguang YUN, Haoyu DUAN, Junfeng YE. Risk factors for biliary stricture and prognosis after orthotopic liver transplantation[J]. Journal of Clinical Hepatology, 2024, 40(11): 2253-2259. doi: 10.12449/JCH241119 |
| [2] | Bingbing ZHU, Jinxiang YANG, Qun ZHANG, Fangyuan GAO, Xianbo WANG. Risk factors for the 90-day prognosis of patients with type I hepatorenal syndrome and establishment of a predictive model[J]. Journal of Clinical Hepatology, 2022, 38(7): 1561-1565. doi: 10.3969/j.issn.1001-5256.2022.07.019 |
| [3] | Siqin LIU, Xiaomei WANG, Xia LI, Luwen LIANG, Ke WANG, Rui WANG. Covert hepatic encephalopathy in liver cirrhosis: Risk factors and prognosis[J]. Journal of Clinical Hepatology, 2022, 38(2): 359-364. doi: 10.3969/j.issn.1001-5256.2022.02.020 |
| [4] | Wanshu LIU, Lijun SHEN, Qinghui ZHAI, Shaojie XIN, Shaoli YOU. Risk factors for acute variceal bleeding in acute-on-chronic liver failure and its influence on prognosis[J]. Journal of Clinical Hepatology, 2022, 38(11): 2532-2536. doi: 10.3969/j.issn.1001-5256.2022.11.018 |
| [5] | Zhang WenJia, Zhao LiJuan, Wu JiZhou. Value of MELD、AARC、COSSH ccoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2020, 36(4): 813-817. doi: 10.3969/j.issn.1001-5256.2020.04.021 |
| [6] | Zhang DaLi, Feng DanNi, Zhang LiJuan, Tang RuJia, He Xi, Zhou Xia, Gao YinJie, Liu ZhenWen, Liu HongLing. Risk factors for recurrence after liver transplantation in patients with hepatocellular carcinoma and their prognosis[J]. Journal of Clinical Hepatology, 2020, 36(9): 1985-1989. doi: 10.3969/j.issn.1001-5256.2020.09.015 |
| [7] | Wang Yu, Hu JinHua. Clinical features of patients with liver failure and fungal infections and influencing factors for prognosis[J]. Journal of Clinical Hepatology, 2019, 35(2): 419-423. doi: 10.3969/j.issn.1001-5256.2019.02.041 |
| [8] | Wang FengJiao, Liu MingJiang, Wu RuiHong, Niu JunQi. A multivariate logistic regression analysis of short-term prognosis of patients with hepatic encephalopathy[J]. Journal of Clinical Hepatology, 2017, 33(4): 711-714. doi: 10.3969/j.issn.1001-5256.2017.04.022 |
| [9] | Li Ying, Zhan Jing, Wang ZhongFeng. Prognostic factors for patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2017, 33(3): 497-501. doi: 10.3969/j.issn.1001-5256.2017.03.020 |
| [10] | Zhang Xin, Gan QiaoRong, Wang Ning, Pan Chen. Analysis of influencing factors for short-term outcome in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2015, 31(5): 706-710. doi: 10.3969/j.issn.1001-5256.2015.05.018 |
| [11] | Wang Xian, Wang ShaoYang, Huang DeDong, Chen Jian, Chen DeLiang. Analysis of short-term prognostic factors in patients with HBV-related acute-on-chronic liver failure treated with artificial liver support system[J]. Journal of Clinical Hepatology, 2014, 30(4): 367-369. doi: 10.3969/j.issn.1001-5256.2014.04.020 |
| [12] | Ye PeiYan, Yang ZongGuo, Chen XiaoRong, Lu YunFei. Risk factors associated with prognosis of progressive stages of acute-on-chronic hepatitis B liver failure[J]. Journal of Clinical Hepatology, 2013, 29(4): 270-275. |
| [13] | Wu XiaoQing, Wan Hong. Causes of liver failure and impact analysis of prognostic risk factors[J]. Journal of Clinical Hepatology, 2013, 29(4): 294-296+304. |
| [14] | Peng JianPing, Sun KeWei, Wu YuNan. Impact of early virological response to antiviral treatment on the outcomes of hepatitis B-associated liver failure [J]. Journal of Clinical Hepatology, 2012, 28(10): 752-755. |
| [15] | Liu HongHong, Fu JunLiang, Fu BaoYun, Zhang Zheng, Xu RuoNan, Luo ShengQiang, Shi Ming, Li YongGang, Wang FuSheng. The pathogenesis and risk factors related to prognosis of primary biliary cirrhosis[J]. Journal of Clinical Hepatology, 2012, 28(2): 153-155. |
| [16] | Lu: RiYing, Li ShiXiong, Wu JiZhou, Zhu YuJia, Fu ShaoPing. Development of a prognostic factors model for severe hepatitis[J]. Journal of Clinical Hepatology, 2012, 28(10): 789-792. |
| [17] | Zhang DongQing, Chen Li, Gan QiaoRong, Zhou Rui, Huang JianRong, Pan Chen. Prognostic factors for hepatitis B acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2012, 28(10): 740-743. |
| [20] | Ding HuiGuo, Gao GuiJu, Chen Tao, Jin Rui. Prognosis of Severe Types of Virous Hepatitis: Study on Mutiple Risk Factors.[J]. Journal of Clinical Hepatology, 2002, 18(5): 297-299. |
| 1. | 房致永，石智尧，高宇，刘懿婵，王晞星. 国医大师王晞星分期论治失代偿期肝硬化黄疸经验. 长春中医药大学学报. 2025(02): 139-143 .  | |
| 2. | 曹志军，汪晓军. 中西医联合治疗乙肝肝硬化的临床进展. 世界复合医学(中英文). 2024(01): 189-194 . | |
| 3. | 胡勤勤，姜阳，张玉龙，方玉，梁仁容，杨华. 肝硬化患者4D flow MRI血流动力学参数与中医证型的相关性研究. 中国中医急症. 2024(06): 982-985+989 . | |
| 4. | 杨渊，钟欣，刘兴宁，彭蓝芬，孙嘉玲，孙新锋，周小舟. 周小舟基于肝脾同调论治肝硬化睡眠障碍经验. 广州中医药大学学报. 2024(11): 3035-3039 . | |
| 5. | 徐石巧，范光明，杜明良，韦莎莎，周楠，罗弦. 基于影像学指标的肝硬化中医微观辨证分型研究进展. 贵州中医药大学学报. 2024(06): 87-90 . | |
| 6. | 黄福莲，陈叶平，李佩. ADA、GGT、TBA、hs-CRP及ChE检测在肝硬化诊断中的应用价值分析. 现代诊断与治疗. 2024(19): 2931-2932+2935 . | |
| 7. | 徐菁，刘坤，马竹芳. 柔肝补肾汤结合熊去氧胆酸对原发性胆汁性肝硬化疗效、肝功能影响研究. 中华中医药学刊. 2023(04): 247-250 . | |
| 8. | 李庆华，胡薇，高涛. 常规生化检验项目对慢性乙型肝炎的应用价值. 系统医学. 2023(03): 59-61+66 . | |
| 9. | 晏梦恬，史红专，郭巧生，江汇瀛，朱雅婷，朱再标. 生长环境土壤水分对垂盆草利湿退黄药效及黄酮类成分的影响研究. 中国中药杂志. 2023(21): 5750-5758 . | |
| 10. | 谢璐，王晓韵，童璐璐. 我院肝胆病科疾病患者的中医药用药特色分析与管理措施. 中医药管理杂志. 2023(20): 234-236 . | |
| 11. | 胡钰玲，李晓阳，尧捷，李校. 慢性乙型肝炎中医证型与现代医学诊断的相关性研究进展. 中医药导报. 2023(12): 96-101 . | |
| 12. | 王惠琴，严永敏，张颖. 肝硬化患者的临床肝功能生化检验效果研究. 智慧健康. 2023(27): 175-178 . | |
| 13. | 邱建华. PLT联合凝血功能检测对早期肝硬化的诊断价值分析. 现代诊断与治疗. 2023(22): 3433-3435 . | |
| 14. | 魏涛华，钱南南，杨文明，谢道俊，鲍远程，童建兵，郝文杰，杨悦. 基于肝脏硬度值联合多维指标探讨不同中医证型Wilson病肝纤维化的临床特征. 中西医结合心脑血管病杂志. 2022(15): 2738-2742 . |
Figures(3) / Tables(4)
The first journal specializing in hepatobiliary and pancreatic diseases in China
Supervisor：Ministry of Education of the People's Republic of China
Sponsor：Jilin University
Academic Support: Chinese Society of Hepatology，Chinese Medical Association
Address: 461 Xinjiang Road, Changchun
Submit：0431-88782044
Peer review：0431-88783542
Email：lcgdb@vip.163.com
Website Design © 2020 Editorial Board of Journal of Clinical Hepatology
吉ICP备10000617号-1
Supported by: Beijing Renhe Information Technology Co. Ltd
Zhang YanFang, Yang FuNing, Che YuanYuan, Huang Jing. Diagnostic value of serum YKL-40 for liver fibrosis stage: A meta-analysis[J]. J Clin Hepatol, 2018, 34(9): 1896-1900. DOI: 10.3969/j.issn.1001-5256.2018.09.014.
| 证型 | 例数 | 性别 | 年龄（岁） | |
| 男(例) | 女(例) | |||
| 肝郁脾虚证 | 160 | 120 | 40 | 42.96±10.74 |
| 肝胆湿热证 | 84 | 60 | 24 | 43.17±11.12 |
| 肝肾阴虚证 | 13 | 8 | 5 | 45.46±10.41 |
| 脾肾阳虚证 | 5 | 4 | 1 | 46.60±9.74 |
| 瘀血阻络证 | 65 | 46 | 19 | 47.80±10.92 |
| 统计值 | χ2=1.569 | F=2.451 | ||
| P值 | 0.814 | 0.056 | ||
| 相关指标 | 肝郁脾虚证(n=160) | 肝胆湿热证(n=84) | 瘀血阻络证(n=65) | 统计量 | P值 |
| PLT(×109/L) | 138.00(85.25~177.25) | 110.50(92.25~142.75) | 44.00(34.00~55.50)1)2) | χ2=155.337 | ＜0.05 |
| ALT(U/L) | 34.00(21.95~43.63) | 68.85(48.75~109.43)1) | 29.50(17.95~39.75)2) | χ2=123.210 | ＜0.05 |
| AST(U/L) | 28.95(23.60~39.63) | 61.40(40.15~94.03)1) | 27.60(21.55~38.05)2) | χ2=86.659 | ＜0.05 |
| Alb(g/L) | 44.97±3.13 | 46.25±3.331) | 31.41±2.461)2) | F=542.512 | ＜0.05 |
| GLB(g/L) | 29.04±4.46 | 28.76±4.71 | 29.09±4.62 | F=0.128 | 0.88 |
| GGT(U/L) | 31.20(20.83~53.13) | 39.10(27.33~65.15)1) | 27.70(21.70~44.05)2) | χ2=13.079 | ＜0.05 |
| 门静脉主干宽度(mm) | 12.79±0.76 | 12.18±0.991) | 13.40±0.581)2) | F=43.373 | ＜0.05 |
| LSM值(kPa) | 16.00(13.40~18.08) | 18.65(16.63~25.00)1) | 24.40(22.30~26.50)1)2) | χ2=131.312 | ＜0.05 |
| APRI | 1.10(0.62~1.35) | 1.30(0.88~2.00)1) | 1.55(1.26~2.31)1) | χ2=54.280 | ＜0.05 |
| FIB-4 | 1.90(1.38~2.74) | 2.66(1.99~3.54)1) | 6.19(4.66~8.37)1)2) | χ2=129.893 | ＜0.05 |
| GPR | 0.67(0.27~1.18) | 0.81(0.49~1.27)1) | 1.52(0.94~2.46)1)2) | χ2=57.485 | ＜0.05 |
| RPR | 0.37±0.16 | 0.39±0.10 | 1.10±0.341)2) | F=351.219 | ＜0.05 |
| 注：与肝郁脾虚证相比，1)P＜0.05；与肝胆湿热证相比, 2)P＜0.05。 | |||||
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.982(0.955~0.995) | 0.875 | 98.12 | 89.33 | 95.2 | 95.7 | 9.20 | 0.02 |
| APRI | 0.899(0.853~0.934) | 0.629 | 86.87 | 76.00 | 88.5 | 73.1 | 3.62 | 0.17 |
| FIB-4 | 0.950(0.913~0.974) | 0.776 | 85.62 | 92.00 | 95.8 | 75.0 | 10.70 | 0.16 |
| GPR | 0.618(0.553~0.680) | 0.303 | 55.63 | 74.67 | 82.4 | 44.1 | 2.20 | 0.59 |
| RPR | 0.752(0.692~0.806) | 0.533 | 61.25 | 92.00 | 94.2 | 52.7 | 7.66 | 0.42 |
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.922(0.868~0.958) | 0.806 | 95.24 | 85.33 | 87.9 | 94.1 | 6.49 | 0.06 |
| APRI | 0.834(0.767~0.888) | 0.570 | 80.95 | 76.00 | 79.1 | 78.1 | 3.37 | 0.25 |
| FIB-4 | 0.848(0.783~0.900) | 0.536 | 86.90 | 66.67 | 74.5 | 82.0 | 2.61 | 2.61 |
| GPR | 0.844(0.778~0.896) | 0.553 | 72.62 | 82.67 | 82.4 | 72.9 | 4.19 | 0.33 |
| RPR | 0.958(0.914~0.983) | 0.777 | 85.71 | 92.00 | 92.3 | 85.2 | 10.71 | 0.16 |
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.969(0.925~0.991) | 0.893 | 100.00 | 89.33 | 89.0 | 100.0 | 9.37 | 0.00 |
| APRI | 0.895(0.831~0.940) | 0.731 | 98.46 | 74.67 | 77.1 | 98.2 | 3.89 | 0.02 |
| FIB-4 | 0.949(0.899~0.979) | 0.845 | 93.85 | 90.67 | 89.7 | 94.4 | 10.05 | 0.07 |
| GPR | 0.941(0.888~0.973) | 0.765 | 93.85 | 82.67 | 82.4 | 93.9 | 5.41 | 0.07 |
| RPR | 0.935(0.880~0.969) | 0.893 | 100.00 | 89.33 | 89.0 | 100.0 | 9.37 | 0.00 |
| 证型 | 例数 | 性别 | 年龄（岁） | |
| 男(例) | 女(例) | |||
| 肝郁脾虚证 | 160 | 120 | 40 | 42.96±10.74 |
| 肝胆湿热证 | 84 | 60 | 24 | 43.17±11.12 |
| 肝肾阴虚证 | 13 | 8 | 5 | 45.46±10.41 |
| 脾肾阳虚证 | 5 | 4 | 1 | 46.60±9.74 |
| 瘀血阻络证 | 65 | 46 | 19 | 47.80±10.92 |
| 统计值 | χ2=1.569 | F=2.451 | ||
| P值 | 0.814 | 0.056 | ||
| 相关指标 | 肝郁脾虚证(n=160) | 肝胆湿热证(n=84) | 瘀血阻络证(n=65) | 统计量 | P值 |
| PLT(×109/L) | 138.00(85.25~177.25) | 110.50(92.25~142.75) | 44.00(34.00~55.50)1)2) | χ2=155.337 | ＜0.05 |
| ALT(U/L) | 34.00(21.95~43.63) | 68.85(48.75~109.43)1) | 29.50(17.95~39.75)2) | χ2=123.210 | ＜0.05 |
| AST(U/L) | 28.95(23.60~39.63) | 61.40(40.15~94.03)1) | 27.60(21.55~38.05)2) | χ2=86.659 | ＜0.05 |
| Alb(g/L) | 44.97±3.13 | 46.25±3.331) | 31.41±2.461)2) | F=542.512 | ＜0.05 |
| GLB(g/L) | 29.04±4.46 | 28.76±4.71 | 29.09±4.62 | F=0.128 | 0.88 |
| GGT(U/L) | 31.20(20.83~53.13) | 39.10(27.33~65.15)1) | 27.70(21.70~44.05)2) | χ2=13.079 | ＜0.05 |
| 门静脉主干宽度(mm) | 12.79±0.76 | 12.18±0.991) | 13.40±0.581)2) | F=43.373 | ＜0.05 |
| LSM值(kPa) | 16.00(13.40~18.08) | 18.65(16.63~25.00)1) | 24.40(22.30~26.50)1)2) | χ2=131.312 | ＜0.05 |
| APRI | 1.10(0.62~1.35) | 1.30(0.88~2.00)1) | 1.55(1.26~2.31)1) | χ2=54.280 | ＜0.05 |
| FIB-4 | 1.90(1.38~2.74) | 2.66(1.99~3.54)1) | 6.19(4.66~8.37)1)2) | χ2=129.893 | ＜0.05 |
| GPR | 0.67(0.27~1.18) | 0.81(0.49~1.27)1) | 1.52(0.94~2.46)1)2) | χ2=57.485 | ＜0.05 |
| RPR | 0.37±0.16 | 0.39±0.10 | 1.10±0.341)2) | F=351.219 | ＜0.05 |
| 注：与肝郁脾虚证相比，1)P＜0.05；与肝胆湿热证相比, 2)P＜0.05。 | |||||
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.982(0.955~0.995) | 0.875 | 98.12 | 89.33 | 95.2 | 95.7 | 9.20 | 0.02 |
| APRI | 0.899(0.853~0.934) | 0.629 | 86.87 | 76.00 | 88.5 | 73.1 | 3.62 | 0.17 |
| FIB-4 | 0.950(0.913~0.974) | 0.776 | 85.62 | 92.00 | 95.8 | 75.0 | 10.70 | 0.16 |
| GPR | 0.618(0.553~0.680) | 0.303 | 55.63 | 74.67 | 82.4 | 44.1 | 2.20 | 0.59 |
| RPR | 0.752(0.692~0.806) | 0.533 | 61.25 | 92.00 | 94.2 | 52.7 | 7.66 | 0.42 |
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.922(0.868~0.958) | 0.806 | 95.24 | 85.33 | 87.9 | 94.1 | 6.49 | 0.06 |
| APRI | 0.834(0.767~0.888) | 0.570 | 80.95 | 76.00 | 79.1 | 78.1 | 3.37 | 0.25 |
| FIB-4 | 0.848(0.783~0.900) | 0.536 | 86.90 | 66.67 | 74.5 | 82.0 | 2.61 | 2.61 |
| GPR | 0.844(0.778~0.896) | 0.553 | 72.62 | 82.67 | 82.4 | 72.9 | 4.19 | 0.33 |
| RPR | 0.958(0.914~0.983) | 0.777 | 85.71 | 92.00 | 92.3 | 85.2 | 10.71 | 0.16 |
| 无创诊断方法 | AUC(95%CI) | cut-off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 |
| LSM值 | 0.969(0.925~0.991) | 0.893 | 100.00 | 89.33 | 89.0 | 100.0 | 9.37 | 0.00 |
| APRI | 0.895(0.831~0.940) | 0.731 | 98.46 | 74.67 | 77.1 | 98.2 | 3.89 | 0.02 |
| FIB-4 | 0.949(0.899~0.979) | 0.845 | 93.85 | 90.67 | 89.7 | 94.4 | 10.05 | 0.07 |
| GPR | 0.941(0.888~0.973) | 0.765 | 93.85 | 82.67 | 82.4 | 93.9 | 5.41 | 0.07 |
| RPR | 0.935(0.880~0.969) | 0.893 | 100.00 | 89.33 | 89.0 | 100.0 | 9.37 | 0.00 |
下载:
DownLoad:
