非侵入性指标预测慢性乙型肝炎严重程度价值分析

Value of non-invasive parameters in predicting severity of chronic hepatitis B

目的 探讨应用非侵入性指标预测慢性乙型肝炎患者肝组织学改变程度的价值.方法 纳入2013年1-12月山东省青岛市中心医院78例初发慢性乙型肝炎患者,记录其基本临床资料及常规实验室检查结果,计算天冬氨酸转氨酶（AST）/丙氨酸转氨酶（ALT）比值（AAR）、AAR/血小板比值（AARPRI）、AST/血小板比值（APRI）、年龄/血小板比值（API）数值.对所有患者进行经皮肝活检,按肝组织炎症活动度（NIA）分为轻度肝炎和中重度肝炎;按肝纤维化程度分为轻度肝纤维化和中重度肝纤维化.运用多种统计学方法评估AAR、AARPRI、APRI、API、年龄等指标与肝NIA和纤维化程度的关系.结果 轻度肝炎患者（44例）AAR、AARPRI、APRI、API分别为（0.78±0.37）、（0.58±0.28）、（0.83 ±0.47）、（2.59±1.85）,中重度肝炎患者（34例）分别为（0.73±0.25）、（0.61±0.30）、（3.15±1.93）、（3.92±2.31）;轻度肝纤维化患者（43例）AAR、AARPRI、APRI、API分别为（0.76±0.33）、（0.57±0.27）、（0.85 ±0.50）、（2.70±1.87）,中重度肝纤维化患者（35例）分别为（0.75±0.31）、（0.62±0.31）、（3.18±1.92）、（3.80±2.36）.中重度肝炎患者APRI、API明显高于轻度肝炎患者,中重度肝纤维化患者APRI、API明显高于轻度肝纤维化患者,差异均有统计学意义（均P ＜0.05）.Spearman秩相关检验表明年龄、AST、ALT、AARPRI、APRI和API与肝组织学NIA分级（r=0.23、0.31、0.22、0.25、0.37、0.36,均P＜0.05）和肝纤维化程度显著相关（r=0.31、0.30、0.22、0.24、0.38、0.31,均P＜0.05）.APRI[比值比（OR）=2.35,P=0.01]和年龄（OR=1.04,P＜0.01）是肝NIA分级的独立预测因子.AARPRI（OR=3.80,P=0.07）、年龄（OR=1.04,P=0.02）和ALT（OR=1.01,P＜0.01）水平是肝纤维化的独立预测因子.应用受试者工作特征曲线进一步分析却显示上述预测因子都不具备很好的预测价值（曲线下面积＜0.70）,其中APRI预测效能最高,敏感度和特异度分别为0.65和0.71.结论 仅APRI对肝脏疾病的预测具有较高敏感度和特异度,有可能用于慢性乙型肝炎严重程度的预测.

Objective To assess the value of non-invasive parameters in predicting severity of chronic hepatitis B （CHB）.Methods Clinical data of 78 patients with untreated CHB from January to December 2013 were retrospectively analyzed.The demographic characteristics and laboratory parameters were recorded.The ratioof aspartate aminotransferase （AST） to alanine aminotransferase （ALT） （AAR）,ratio of AAR to platelet count （AARPRI）,ratio of AST toplatelet count （APRI）,and ratio age to platelet count （API） were calculated.Thepercutaneous liver biopsy was preformed to determine the mild,moderate/severe inflammation,mild hepatic fibrosis and moderate/severe hepatic fibrosis.The correlations of between AAR,AARPRI,APRI,API,age and degree of hepatic inflammation and fibrosis were analyzed.Results AAR,AARPRI,APRI,API were （0.78 ±0.37）,（0.58 ±0.28）,（0.83 ±0.47）,（2.59 ± 1.85） in mild hepatitis patients;they were （0.73 ± 0.25）,（0.61 ± 0.30）,（3.15 ± 1.93）,（3.92 ± 2.31） in moderate/severe hepatitis patients,respectively.AAR,AARPRI,APRI,API were （0.76 ± 0.33）,（0.57 ± 0.27）,（0.85 ± 0.50）,（2.70 ± 1.87） in patients with mild hepatic fibrosis;they were（0.75 ± 0.31）,（0.62 ± 0.31）,（3.18 ± 1.92）,（3.80 ± 2.36） in patients with severe hepatic fibrosis.APRI and API were significantly higher in moderate/severe hepatitis patients than those in mild hepatitis patients.The age,AST,ALT,AARPRI,APRI and API were significantly correlated with degree of hepatic inflammation （r =0.23,0.31,0.22,0.25,0.37,0.36） and fibrosis （r =0.31,0.30,0.22,0.24,0.38,0.31） （P 〈 0.05）.The independent risk factors of degree of hepatic inflammation included APRI （odds ratio =2.35,P =0.01） and age （odds ratio =1.04,P 〈 0.01）;the independent predictors of hepatic fibrosis included AARPRI （odds ratio =3.80,P =0.07）,age （odds ratio =1.04,P =0.02）,and ALT （odds ratio =1.01,P 〈 0.01）.Conclusion The APRI can help to predict the severity of liver disease in patients with CHB.