利用联合诊断评价慢性乙型肝炎患者肝纤维化程度

Assessing liver fibrosis progression in patients with CHB by using combined diagnosis

目的了解实验室检测指标的平行和系列联合在判断慢性乙型肝炎患者肝纤维化程度的作用。方法调查322例乙型肝炎表面抗原(HBsAg)阳性的乙型肝炎患者,利用ROC曲线计算曲线下面积(AUROC),判断最优截断点并计算各指标的平行联合和系列联合时的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)、Youden指数。结果AUROC>0.7的有谷氨酸转肽酶(GGT)、天冬氨酸转氨酸(AST)和血小板(PLT)的比值(APRI)、年龄和PLT的比值(AGE-PLT)和AST,分别为0.772、0.769、0.748和0.700。AGE-PLT和AST平行联合时灵敏度和阴性预测值最高(89.36%,92.06%),GGT和AGE-PLT系列联合时特异度和阳性预测值最高(96.05%,85.25%)。结论对于HBsAg阳性的慢性乙型肝炎患者,可以尝试用实验室的直接或间接指标的平行联合和系列联合来诊断肝纤维化的程度。

Objective To verify the value of parallel and serial interpretation to assess liver fibrosis progression in patients with chronic hepatitis B. Methods 322 patients with liver biopsy and a positive HBsAg were included in this study. The AUROC and cut-offs of certain markers were identified by using receiver operating characteristic （ROC） curves. Sensitivity, specificity, positive and negative predictive values, and Youden index of these markers were calculated in parallel and serial. Results The AUROC above 0.7 showed the following values： 0.772 （GGT）, 0.769 （APRI）, 0,748 （AGE-PLT） and finally 0.700 （AST）. The highest possible sensitivity and NPV is stained with the parallel interpretation ASTOAGE-PLT at 89,36% and 92,06%. The combination of GGTrIAGE-PLT in serial was permitted to obtain the best specificity and PPV at 96.05% and 85.25%. Conelusion We may assess the degree of liver fibrosis using parallel and serial interpretation of laboratory markers in patients with chronic hepatitis B.