原发性胆汁性肝硬化无创性肝纤维化诊断模型的建立

A noninvasive diagnostic model of liver fibrosis using serum markers in primary biliary cirrhosis

目的采用常规实验室指标建立原发性胆汁性肝硬化（PBC）无创性肝纤维化诊断模型，验证并评判其诊断价值。方法收集2003年1月-2011年6月于首都医科大学附属北京友谊医院经肝活检确诊为PBC的患者73例，将其常规实验室指标与组织学分期进行相关性分析和logistic回归分析，创建肝纤维化诊断模型。结果建立了一个由血小板计数、血清胆碱酯酶、白蛋白、HDL．C和凝血酶原活动度5个常规指标组成的预测模型——H指数，其判断进展期纤维化（Ⅲ-Ⅳ期）的AUCROC为0．861，H指数〈-2．20预测早期纤维化（Ⅰ-Ⅱ期）的敏感性为96．6％，H指数〉0．41预测存在进展期纤维化的特异性为93．2％。结论本研究由常规实验室指标建立的肝纤维化无创诊断模型能协助准确区分PBC患者的早期（Ⅰ～Ⅱ期）和进展期（Ⅲ一Ⅳ期）病变。

Objective To verify and assess diagnostic value of noninvasive diagnostic model of liver fibrosis in primary biliary cirrhosis （PBC） based on conventional laboratory markers. Methods Seventy- three patients with PBC diagnosed by liver biopsy between January 2003 and June 2011 in Beijing Friendship Hospital, Capital Medical University were recruited in this study. Correlation analysis and logistic regression analysis between the conventional laboratory markers and histology stages were assessed. A liver fibrosis diagnostic model was established based upon aforementioned biomarkers and verified by its sensitivity and specificity for predicting the liver fibrosis. Results The predictive model （H index） consisting of five conventional laboratory markers, i.e., platelet count, serum cholinesterase, albumin, HDL-C and prothrombin time activity, could predict advanced fibrosis （ stagesⅢ-Ⅳ） with an AUCaoc of 0. 861. The sensitivity of predicting the absence of advanced fibrosis using H index 〈 - 2. 20 was 96. 6% and the specificity of predicting the presence of advanced fibrosis using H index 〉 0. 41 was 93.2%. Conclusion The established noninvasive diagnostic model consisting of five laboratory markers could accurately distinguish pathological changes of early stage PBC （ stages Ⅰ -Ⅱ） from advanced stage PBC （ stages m-iv）.