简易无创模型诊断慢性乙型肝炎肝纤维化的价值比较

Noninvasive models in diagnosis of liver fibrosis in patients with chronic hepatitis B

目的：比较和评价6个简易无创模型诊断慢性乙型肝炎（ CHB）肝纤维化的临床价值。方法连续收集2003年3月至2013年10月沈阳市第六人民医院的CHB住院患者838例，所有病例均接受了肝穿刺活检、B超检查，并同时进行了血液检测。利用受试者工作特征曲线下面积（ AUROC）评价天冬氨酸转氨酶／丙氨酸转氨酶（AAR）、AST／血小板计数比值（APRI）、年龄-血小板指数（API）、肝硬化判别式值（CDS）、脾脏／血小板比值指数（SPRI）和年龄-脾脏／血小板比值指数（ASPRI）诊断显著肝纤维化（S2～4）、进展期肝纤维化（S3～4）和早期肝硬化（S4）的价值。结果6个诊断模型中，APRI诊断肝纤维化程度的AUROC均＜0．7，AAR、API、CDS、SPRI、ASPRI的AUROC均＞0．7。其中，ASPRI诊断显著肝纤维化、进展期肝纤维化、早期肝硬化的AUROC分别为0．861、0．873、0.881，灵敏度和特异度分别为69．4％和87．9％、76．9％和81．5％、87．0％和75．8％，阳性预测值和阴性预测值分别为90.9％和62．2％、74．9％和83．1％、46．1％和96．1％。若以＜5．2和≥9．7作为排除和诊断显著肝纤维化的界值，可使49．4％（414／838）的患者避免肝活检，准确率为92．3％（382／414）。结论 ASPRI对CHB患者的显著肝纤维化和早期肝硬化具有较好的诊断价值，并可减少部分肝穿刺活检的必要。

Objective To compare different noninvasive models in diagnosis of liver fibrosis in patients with chronic hepatitis B （CHB）.Methods A total of 838 CHB patients admitted in Shenyang Sixth People’ s Hospital during March 2003 and October 2013 were enrolled in the study.All the patients received liver biopsy, blood and ultrasound examinations; the AST-to-ALT ratio （ AAR）, AST to platelet ratio index （ APRI） , age platelet index （ API） , cirrhosis discriminant score （ CDS） , spleen to platelet ratio index （ SPRI） and age-spleen to platelet ratio index （ ASPRI） were obtained.Area under receiver operating characteristic curve （AUROC） was used to assess the clinical value of noninvasive models in diagnosis of significant liver fibrosis （S2-4）, advanced liver fibrosis （S3-4） and early liver cirrhosis （S4）.Results Among six noninvasive models, APRI had the lowest value of AUROCs （ 〈0.7）, while ASPRI had the highest AUROCs value in diagnosis of liver fibrosis.The AUROCs of ASPRI in diagnosing significant liver fibrosis, advanced liver fibrosis and early liver cirrhosis were 0.861, 0.873 and 0.881 with the sensitivities of 69.4%, 76.9%and 87.0%, the specificities of 87.9%, 81.5% and 75.8%, the positive predictive values of 90.9%, 74.9%and 46.1%and the negative predictive values of 62.2%, 83.1%and 96.1%, respectively.Taking〈5.2 and≥9.7 as the cut-off values for exclude significant liver fibrosis and diagnosis of significant liver fibrosis, respectively, 49.4%（414/838） of the patients may avoid liver biopsy with an accuracy of 92.3%（382/414）.Conclusion ASPRI is of value in diagnosing significant liver fibrosis and early liver cirrhosis in patient with chronic hepatitis B, and the number of liver biopsy can be reduced.