慢性肝脏疾病肝纤维化非创伤性诊断模型的研究

Research of non-invasive diagnosis model of fibrosis in chronic liver disease

目的:建立一个基于临床、血清学及超声检查等指标的非创伤性肝纤维化诊断模型。方法:慢性肝脏疾病患者271例,随机分成建模组190例和验证组81例,均行肝组织病理学检查,同时检测记录17项临床、血清学及超声检测指标的结果。在建模组对各指标依次行单因素分析和多因素Logistic回归分析,筛选出与研究终点相关的独立危险因素,在此基础上构建非创伤性肝纤维化诊断模型,最后用独立的验证组检验该模型的诊断效率。结果:在单因素分析有统计学意义的10个因素中,筛选出3个独立的危险因素凝血酶原时间的国际标准化比值、碱性磷酸酶和肝中静脉内径,并建立由这3个因素组成的非创伤性肝纤维化诊断模型。S0和S1评分低于S2,S3和S4(P<0.01);非创伤性肝纤维化诊断模型评分与肝纤维化分期呈正相关(γs=0.545,P<0.01);ROC曲线分析显示非创伤性肝纤维化诊断模型诊断显著肝纤维化(S2-4)、严重肝纤维化(S3-4)和肝硬化(S4)的AUC分别为0.757,0.748和0.903,最佳诊断值分别为5.47,6.09和6.97,其诊断准确度分别为75.8%,70%和88.9%。非创伤性肝纤维化诊断模型应用于验模组,其诊断显著肝纤维化、严重肝纤维化和肝硬化的特征曲线下面积分别为0.737,0.721和0.908。结论:应用非创伤性肝纤维化诊断模型评分评估慢性肝脏疾病的肝纤维化程度具有较好的准确度和可重复性,有望在一定程度上替代肝组织病理检查来监测慢性肝脏疾病的肝纤维化的动态变化。

Objective To develop a non-invasive diagnosis model of fibrosis based on clinical, serum markers and ultrasonography checking in chronic liver disease. Methods Two hundred and seventy-one patients with chronic liver disease were randomly divided into an estimation group （190 cases） and a validation group （81 cases）. Liver biopsies and hepatic tissue pathology checking were done. Seventeen clinical, serum markers and ultrasonography checking were detected and recorded in the estimation group. The independent hazard factors were screened according to single factor analysis and multiple factor Logistic regression analysis. The non-invasive diagnosis model of fibrosis was established according to the independent hazard factors and applied to the validation group to test its accuracy. Results Among 10 variables associated with liver fibrosis selected by single factor analysis, international normalized ratio of prothrombin time, alkali phosphatase and middle hepatic vein were identified by multiple factor Logistic regression analysis as independent hazard factors of fibrosis. The non-invasive diagnosis model of fibrosis constructed from the above three factors was established. The scores of non-invasive diagnosis model of fibrosis in SO and S1 were lower than those of S2,S3 and S4 （P〈 0. 01）. There was positive correlation between the score of non-invasive diagnosis model of fibrosis and the stages of fibrosis（Ts=0. 545, P〈0.01）. In the receiver operating characteristic curve （ROC） analysis, the areas under ROC （AUC） of significant fibrosis, extensive fibrosis and cirrhosis were0.757, 0.748 and 0.903, respectively. The best diagnosis values were 5.47, 6.09 and 6. 97, respectively. The diagnosis accuracies were 75. 8%, 70% and 88. 9%; respectively. The AUC of significant fibrosis, extensive fibrosis and respectively. Conclusion There is better diagnosis model of fibrosis in evaluating t diagnosis model of fibrosis could be used disease. cirrhosis in validation group were 0. 737, 0. 721 and 0. 908, accuracy and reproducible with the score of non-invasive he stages of fibrosis of chronic liver disease. Non-invasive to replace liver biopsy to dynamic changes of chronic liver disease.