慢性乙型肝炎肝纤维化非创伤性诊断评分表模型的建立

Assessment of noninvasive diagnosis model of fibrosis in chronic hepatitis B

目的从慢性乙型肝炎患者的临床、生物化学及影像学等临床常用的非创伤性指标中,构建诊断肝纤维化的评分表模型。方法 374例临床诊断为慢性乙型肝炎患者,行肝组织活检术,常规检查血常规、生物化学、病毒载量、血清透明质酸(HA)、超声检查肝脏及脾脏厚径、年龄等,根据各临床指标在肝组织病理分期的相对比值,制定各变量的分值,构建诊断肝纤维化的评分表模型,用受试者工作特征曲线(ROC曲线)评价评分表模型的诊断预测能力。结果建模组314例慢性乙型肝炎患者中,由血小板计数、白蛋白/球蛋白(A/G)、脾厚、透明质酸(HA)、年龄5项指标构成判断肝纤维化的评分表模型(SZFibroS模型)。ROC曲线分析显示,SZFibroS≥5.4,诊断≥S2的敏感性为78.2%,特异性为67.7%,受试者工作特征曲线下面积(AUC)为0.8153。60例验证组验证该模型的准确度为76.7%。结论运用该非创伤性评分表模型评价慢性乙型肝炎的肝纤维化程度,简单易记、可重复性好,具有较高的敏感性及准确性,可在一定程度上替代肝组织活检来监测慢性乙型肝炎肝纤维化的动态变化。

Objective To develop a noninvasive diagnosis model of fibrosis based on clinical, serum markers and ultrasonography checking in chronic hepatitis B. Methods Liver biopsy were performed on 374 patients with chronic hepatitis B and staging of fibrosis were assessed. Common clinical indexes, serum markers and ultrasonography checking were detected to develop a diagnosis model of fibrosis. The model was assessed with ROC analysis. It was also applied to the validation group to test its accuracy. Results The model （SZ SZFibroS model） to established fibrosis consisted of platelet count （PLT）, albumin/globin （A/G）, thickness of spleen, hyaluronic acid （HA） and age. ROC analysis showed that, if SZFibroS ≥ 5.4, the sensitivity of discriminating ≥ S2 was 78.2%, the specificity was 67.7%, and AUC for identifying ≥ S2 was 0.8153. Conclusions The model for assessment of liver fibrosis was simple and repeatable. It could be applied to assist or substitute liver biopsy to detect dynamic changes of liver fibrosis with chronic hepatitis B.