γ-谷胺酰转肽酶/血小板计数模型评估慢性乙型肝炎患者肝纤维化的诊断价值

Diagnostic value of GPR on the evaluation of fibrosis degree in patients with chronic hepatitis B

目的评估γ-谷胺酰转肽酶/血小板计数无创模型(GPR)对慢性乙型肝炎(简称乙肝)患者肝纤维化的诊断价值。方法共纳入2009年1月至2013年2月在北京地坛医院住院的慢性乙肝患者217例,根据肝组织病理学结果分为非显著性肝纤维化组178例(S0~S1)和显著性肝纤维化组39例(S2~S4)。分别对两组患者进行血常规、血清生物化学指标、乙肝病毒学标志物及HBV-DNA等检测。参考原始文献构建GPR、丙氨酸氨基转移酶/血小板计数模型(APRI)、基于4项因素的肝纤维化指数模型(FIB-4)3种预测肝纤维化的无创模型。采用SPSS19.0软件进行统计学处理,采用受试者工作特征曲线(ROC)方法评价比较不同无创模型预测慢性乙肝显著肝纤维化的诊断能力。结果两组患者APRI、FIB-4、GPR、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、血小板计数(Plt)、乙肝e抗原(HBe Ag)及HBV-DNA水平比较,差异均有统计学意义(P<0.05)。APRI、GPR、FIB-4,AST、碱性磷酸酶(ALP)和GGT与肝纤维化程度呈显著正相关(r=0.317、0.285、0.290、0.259、0.188、0.238),而Plt、HBe Ag、HBV-DNA与肝纤维化程度呈负相关(r=-0.220、-0.292、-0.255)。GPR、APRI、FIB-4模型的曲线下面积分别为0.714(95%CI 0.619~0.809)、0.739(95%CI 0.647~0.830)、0.718(95%CI 0.624~0.813),其临界值、敏感度、特异度分别为0.21、61.50%、74.70%,0.31、71.80%、69.10%,1.07、59.00%、82.00%。结论GPR模型对慢性乙肝患者肝纤维化程度具有一定的诊断价值,值得在临床推广应用。

Objective To assess the diagnostic value of the GPR on the evaluation of fibrosis degree in the patients with chronic hepatitis B （CHB） patients. Methods A total of 217 CHB patients hospitalized in Beijing Ditan Hospital from January 2009 to February 2013 were selected and divided into non-significant liver fibrosis group （n=178, S0-S1 ） and significant liver fibrosis group （n=39, $2-$4） according to the pathological results of liver tissue. Serological examination was conducted on blood routine, serum biochemical index, hepatitis B virology markers, HBV-DNA and so on. Non-invasive model of GRP, APRI and FIB- 4 for predicting fibrosis degree was established according to the primary documents. SPSS19.0 software was used for statistical analysis,while the ROC curves were adopted to compare the diagnostic capacity of different non-invasive models in predicting fibrosis degree of liver in CHB patients. Results The levels of APRI,FIB-g,GPR,aspartate transferase （AST）,3,-glutamyl transpeptidase （GGT）, blood platelet count （Pit）, hepatitis B e antigen （HBeAg） and HBV-DNA in the two groups had statistically significant difference （P〈O.05）. Fibrosis degree was positively correlated with APRI, GPR, FIB-4, AST, alkaline phosphatase （ALP） and GGT （r=0.317,0.285,0.290,0.259,0.188,0.238）, while the fibrosis degree was negatively correlated with Pit, HBeAg and I-IBV-DNA（r=-0.220,-0.292,-0.255）. The areas under the ROC curve of GPR, APRI and FIB-4 were 0.714 （95%CI 0.619-0.809） ,0.739（95%CI 0.647-0.830）and 0.718（95%CI 0.624-0.813）, respectively. The cut-off value,sensitivity and specificity of GPR were 0.21,61.50% and 7g.70%, respectively; while APRI were 0.31,71.80% and 69.10%, respectively ;FIB-4 were 1.07,59.00% and 82.00% ,respectively. Conclusion GPR has diagnostic value in predicting fibrosis degree in CHB patients to some extent, and it is worthy of clinical promotion and application.