联合应用慢性乙型肝炎肝纤维化非创伤性诊断模型与血清透明质酸的诊断价值

Diagnostic Value of Noninvasive Diagnostic Model of Liver Fibrosis in Combination with Serum Hyaluronic Acid in Patients with Chronic Hepatitis B

背景:肝活检组织病理学检查是肝纤维化诊断的金标准,但其临床应用有一定局限性。目的:联合应用慢性乙型肝炎(CHB)肝纤维化非创伤性诊断模型Fibromodel与血清肝纤维化指标透明质酸(HA),评价其诊断价值。方法:选取130例CHB患者,行肝活检病理分期,以≥S2为显著肝纤维化的分界点,以S4为早期肝硬化的分界点;同时检测相关实验室指标。以接受者操作特征(ROC)曲线分析Fibromodel和血清HA的诊断价值;根据阳性预测值(PPV)和阴性预测值(NPV)评估两者联合应用的诊断价值。结果:Fibromodel对≥S2的曲线下面积(AUC)为0.792,以0.15为界定值排除显著肝纤维化的敏感性、特异性和NPV分别为81.1%、62.4%和87.5%;以0.5为界定值诊断显著肝纤维化的敏感性、特异性和PPV分别为68.1%、76.9%和64.2%。只对Fibromodel介于0.15～0.5之间者行肝活检,可避免46.2%的肝活检,准确性为76.7%。血清HA对≥S2的AUC为0.789,诊断界值为60ng/ml时,敏感性、特异性和NPV分别为76.8%、78.2%和82.9%;对S4的AUC为0.801,诊断界值为140ng/ml时,敏感性、特异性和PPV分别为85.5%、81.6%和82.1%。进一步应用血清HA评价未被Fibromodel确定的患者,可避免60.0%的肝活检,准确性为83.3%。结论:Fibromodel与血清HA联合应用可提高无创评估CHB肝纤维化的诊断效率,在一定程度上可替代肝活检。

Background： Although liver biopsy remains the gold standard for the diagnosis of liver fibrosis, there are still limitations in its clinical application. Aims： To assess the diagnostic value of Fibromodel （a noninvasive diagnostic model of liver fibrosis） in combination with hyaluronic acid （HA, a serum fibrotic marker） in patients with chronic hepatitis B （CHB）. Methods： One hundred and thirty CHB patients were enrolled. Liver biopsy specimens were collected to assess the stage of fibrosis histologically. ≥S2 was defined as significant fibrosis, and S4 as early cirrhosis. The related laboratory markers were determined simultaneously. Receiver operating characteristic （ROC） curve was used to analyze the diagnostic value of Fibromodel and serum HA, and the combination method was evaluated by positive predictive value （PPV） and negative predictive value （NPV）. Results： The area under curve （AUC） of Fibromodel for ≥S2 was 0.792. When the cut off value was set at 0.15, the sensitivity, specificity and NPV for exclusion of significant fibrosis were 81.1%, 62.4% and 87.5%, respectively; when the cut off value was set at 0.5, the sensitivity, specificity and PPV for diagnosis of significant fibrosis were 68.1%, 76.9% and 64.2%, respectively. Biopsies being done in patients with Fibromodel value 0.15-0.5 would reduce the need for liver biopsy by 46.2% with an accuracy rate of 76.7%. The AUC of serum HA for ≥S2 was 0.789. When the cut off value was set at 60 ng/ml, the sensitivity, specificity and NPV were 76.8%, 78.2% and 82.9%, respectively. The AUC of serum HA for S4 was 0.801. When the cut off value was set at 140 ng/ml, the sensitivity, specificity and PPV were 85.5%, 81.6% and 82.1%, respectively. If patients unidentified by Fibromodel were assessed by serum HA, the need for liver biopsy would reduce by 60.0% with an accuracy rate of 83.3%. Conclusions： A combination of Fibromodel with serum HA improves the diagnostic performance for liver fibrosis in CHB patients and may partially replace the liver biopsy.