常规生化项目鉴别诊断慢性肝炎与肝硬化模型的建立和应用

Formulation and application of diagnostic models based on clinical biochemical assays in diagnosis of chronic hepatitis and liver cirrhosis associated with viral hepatitis

目的通过对现有的15项病毒性肝病相关常规生化检验项目的回顾性分析，筛选出应用价值较好的项目，并且通过合理的组合，建立慢性肝病与肝硬化鉴别诊断的评估模型，提高诊断准确度。方法查阅乙型肝炎病毒引起的慢性肝炎和肝硬化患者的病历447份，获得15项肝病相关常规指标的检测结果（丙氨酸转氨酶、天冬氨酸转氨酶、天冬氨酸转氨酶与丙氨酸转氨酶比值、总胆红素、直接胆红素、直接胆红素与总胆红素比值、碱性磷酸酶、了一谷氨酰基转移酶、乳酸脱氢酶、胆碱酯酶、总蛋白、白蛋白、球蛋白、白蛋白与球蛋白比值、总胆汁酸），以该组数据作为训练组，运用Logistic回归统计方法，建立慢性肝炎与肝硬化的鉴别诊断模型；留取乙型肝炎病毒引起的慢性肝炎和肝硬化患者血清213份，测定以上15项指标，并以该组数据作为验证组，对已建模型进行验证。通过计算ROC曲线下面积（AUC），评价诊断模型及各单个指标的诊断价值。结果慢性肝炎和肝硬化鉴别诊断模型由CHE、DBIL、ALB、ALT、GLO五项指标组合构建，训练组AUC达到0、87，验证组AUC达到0．83。结论由CHE、DBIL、ALB、ALT、GLO五项指标组合构建的慢性肝炎和肝硬化鉴别诊断模型，应用效果优于单项指标。

Objective To improve the diagnostic ability of routine laboratory items in liver diseases associated with viral hepatitis through constructing assessment models consisting of these items. Methods （ 1 ） Assessment of routine items and formulation of models. Data of 447 patients seen between May 1997 and August 2003 were collected as the training set and serum specimes of 213 patients taken between June 2004 and March 2005 were examined and used as the validation set. Eleven items（TP, ALB, TBIL, DBIL, ALT, AST, ALP, GGT, TBA, LDH, CHE）were examined with an automated biochemical analyzer. Logistic regression was applied to construct the model for discriminating between chronic hepatitis and liver cirrhosis. The diagnostic value of items and models was assessed by the area under the receiver-operating characteristic （ROC） curve. Results The model to discrimination between chronic hepatitis and liver cirrhosis consists of five items （ CHE, DBIL, ALB, ALT, GLO）. The AUCs of model were 0.87 in the training set and 0.83 in validation set, respectively. Conclusion （ 1 ） The model consisting of CHE, DBIL, ALB, ALT, GLO improves the diagnostic value of routine laboratory items in discriminating chronic hepatitis from liver cirrhosis.