凝血酶原时间在慢性乙型肝炎肝纤维化中的临床价值

Clinical value of prothrombin time in chronic hepatitis B liver fibrosis

目的评价凝血酶原时间(PT)在慢性乙型肝炎(CHB)肝纤维化中的价值。方法 423例经肝活检证实的慢性乙型肝炎患者,收集不同肝纤维化分期的PT、凝血酶原百分活动度(PTA)及国际标准化比值(INR)的检测结果。利用ROC曲线分析判断其诊断肝纤维化以及早期肝硬化的价值。结果 PT、PTA、INR既与炎症分级相关又与纤维化分期相关,偏相关分析显示PT、PTA、INR均与肝纤维化分期有相关性(rp=0.273、-0.273、0.273,均P<0.05)。其中PTA与肝纤维化分期负相关。S0~S4五组间PT、PTA、INR经Kruskal-Wallis H检验差异有统计学意义(H=104.2、104.0、104.2,P=0.000<0.05)。两两比较显示:S0~S2组间PT、PTA、INR比较差异无统计学意义(P>0.05);在S3及S4显著升高或降低,并且S4与S0、S1、S2、S3比较差异有统计学意义(Z=7.941、8.309、7.533、4.723,P<0.05)。S3与S0、S1、S2比较差异有统计学意义(Z=4.094、4.596、3.624,P<0.05)。PT、PTA界值为13.5和78.9%时,诊断早期肝硬化(S4)的AUROC均为0.820,灵敏度为66.3%和66.3%,特异度为85.7%和85.5%,准确率为82.0%和81.8%。结论 PT、PTA对早期肝硬化的诊断具有一定临床价值,但灵敏度较低,需联合其他无创指标综合判断。

Objective To evaluate the value of prothrombin time (PT) in chronic hepatitis B (CHB) liver fibrosis. Methods There were 423 chronic hepatitis B patients confirmed by liver biopsy, and collection were made on testing results of PT, prothrombin activity (PTA) and international normalized ratio (INR) in different liver fibrosis stage. ROC curve analysis was used to determine its value in diagnosis of liver fibrosis and early liver cirrhosis. Results PT, PTA and INR are not only associated with inflammation classification but also associated with fibrosis stage. Partial correlation analysis showed that PT, PTA and INR all have correlation with liver fibrosis stage (rp=0.273, -0.273, 0.273, all P<0.05), and PTA has negative correlation with liver fibrosis stage. S0~S4 five groups had statistically significant difference in PT, PTA and INR by Kruskal-Wallis H test (H=104.2, 104.0, 104.2, P=0.000<0.05). S0~S2 groups had no statistically significant difference in PT, PTA and INR according to pairwise comparison (P>0.05). They were significantly increase or decrease in S3 and S4, and S4 had statistically significant difference compared with S0, S1, S2 and S3 (Z=7.941, 8.309, 7.533, 4.723, P<0.05). S3 had statistically significant difference compared with S0, S1 and S2 (Z=4.094, 4.596, 3.624, P<0.05). When PT, PTA industry value were 13.5 and 78.9%, AUROC in diagnosis of early liver cirrhosis (S4) both was 0.820, with sensitivity as 66.3% and 66.3%, specificity as 85.7% and 85.5%, and accuracy rate as 82.0% and 81.8%. Conclusion PT and PTA have a certain clinical value in diagnosis of early liver cirrhosis, but with low sensitivity and they need to incorporate with other noninvasive indexes for comprehensive judgment.