血清糖类抗原19-9对慢性HBV感染患者肝纤维化的预测价值研究

Prediction value of serum CA19-9 on liver fibrosis in patients with chronic HBV infection

目的通过分析血清糖类抗原19-9（carbohydrate antigen 19-9,CA19-9）和APRI（aspartate aminotransferase-to-platelet ratio index）评分无创评估慢性HBV感染患者显著肝纤维化的临床价值,探索新的肝纤维化无创诊断指标。方法 选取2011年10月~2014年10月经肝活检证实的慢性HBV（hepatitis B virus）感染患者410例,检测所有患者血清CA19-9和其他实验室指标,计算APRI评分。所有患者按肝脏纤维化程度分为两组：276例轻度肝纤维化（S0~S1）和134例显著肝纤维化（S2~S4）,比较不同肝纤维化程度患者血清CA19-9和APRI评分的差异。并采用ROC（Receiver Operating Characteristic）曲线评价血清CA19-9及APRI评分单项及联合应用对显著肝纤维化的诊断价值。结果 血清CA19-9浓度和APRI评分随着肝脏纤维化程度的加深而逐渐升高,且在S0-S4组中的总体差异均有统计学意义（P均〈0.05）。血清CA19-9和APRI评分诊断显著肝纤维化的ROC曲线下面积（AUC）分别为0.70（0.65~0.76）、0.76（0.71~0.81）。对血清CA19-9和APRI评分进行多因素Logistic回归分析构建联合预测模型,其AUC达到0.80。结论 血清CA19-9对慢性HBV感染患者显著肝纤维化的诊断有一定的临床应用价值,与其他指标的联合应用可以有效提高诊断效率。

Objective To analyze the clinical value of serum CA19-9 and APRI scoring system on noninvasive assess- ment in chronic HBV infected patients with significant liver fibrosis, and to explore new noninvasive diagnostic indica- tors. Methods 410 cases of chronic HBV infected patients confirmed by liver biopsy were enrolled from October 2011 to October 2014, and serum CA19-9 and other laboratory indicators in all patients were detected,from which APRI score was calculated. All patients were divided into two groups based on liver fibrosis： 276 cases of mild fibrosis （S0- S1） and 134 cases of significant liver fibrosis （$2 to S4）,and the differences of serum CA19-9 and APRI score were compared among the patients with different liver fibrosis. The individual and combined diagnostic value of serum CA19-9 and APRI score for significant liver fibrosis was evaluated by ROC curve. Results Serum CA19-9 concentra- tion and APRI score gradually increased with liver fibrosis deepening, among the patients with different liver fibrosis. The area under the ROC curve （AUC） of serum CA19-9 and APRI score for the diagnosis of significant fibrosis were 0.70 （0.65 to 0.76） and 0.76 （0.71 to 0.81）. Multivariate logistic regression analysis was made on serum CA19-9 and APRI score to build a joint prediction model, and its AUC was 0.80. Conclusion Serum CA19-9 has some clinical value for the diagnosis of significant liver fibrosis in chronic HBV infected patient, and the diagnostic efficiency can be improved through combinating other indicators.