无创诊断模式预测慢性乙型肝炎合并非酒精性脂肪肝患者肝纤维化的价值

The value of non-invasive diagnostic model in predicting liver fibrosis in patients with chronic hepatitis B combined with non-alcoholic fatty liver disease

目的探讨GGT/PLT比值(GPR)、FIB-4和APRI预测慢性乙型肝炎(CHB)合并非酒精性脂肪肝(NAFLD)患者肝纤维化分期的价值。方法选取广州市第八人民医院2012年1月至2016年12月肝组织活检诊断为CHB合并NAFLD患者122例。分析GPR、FIB-4和APRI预测肝纤维化分期的价值。相关性分析采用Spearman’s相关系数,受试者工作特征(ROC)曲线预测肝纤维化分期。结果肝组织病理活检作为金标准,F1、F2、F3和F4各纳入33例、50例、28例和11例患者。GPR、FIB-4和APRI与肝纤维化呈正相关,相关系数分别为0.220、0.326、0.284( P <0.05)。GPR、FIB-4和APRI均不能预测CHB合并NAFLD明显肝纤维化(F2)。GPR预测进展期肝纤维化(F3)的ROC曲线下面积(AUC)是0.725(0.637~0.802),cut-off值是0.380,灵敏度64.1%,特异度 79.5 %,准确率73.8%,阳性预测值和阴性预测值分别为59.5%和82.5%;FIB-4和APRI预测进展期肝纤维化(F3)AUC分别为0.748(0.661~0.822)和0.745(0.658~0.819),与GPR无显著相关性( P >0.05)。结论 GPR、FIB-4和APRI预测CHB合并NAFLD进展期肝纤维化(F3)具有中等预测价值,但对明显肝纤维化(F2)无预测价值,合并脂肪肝可能影响血清学无创诊断预测肝纤维化的价值。

Objective To investigate the value of GGT/PTL ratio (GPR), FIB-4 and APRI in predicting liver fibrosis stage in patients with chronic hepatitis B (CHB) combined with non-alcoholic fatty liver disease (NAFLD). Methods 122 patients with CHB combined with NAFLD diagnosed by liver biopsy from Jan. 2012 to Dec. 2016 in Guangzhou Eighth People’s Hospital were selected. The value of GPR, FIB-4 and APRI in predicting hepatic fibrosis stage was analyzed. Correlation analysis was done by Spearman’s correlation coefficient, the ROC curve was used to predict the stage of liver fibrosis. Results Liver histopathological biopsy was used as the golden standard, F1, F2, F3 and F4 were included in 33 cases, 50 cases, 28 cases and 11 cases, respectively. GPR, FIB-4 and APRI were positively correlated with liver fibrosis, and the correlation coefficients were 0.220, 0.326 and 0.284 ( P <0.05). GPR, FIB-4 and APRI couldn’t predict significant liver fibrosis (F2) in CHB combined with NAFLD. The AUC of GPR in predicting advanced liver fibrosis (F3) was 0.725 (0.637-0.802), cut-off value was 0.380, sensitivity was 64.1%, specificity was 79.5% and the accuracy rate was 73.8%,while the positive predictive value and negative predictive value were 59.5% and 82.5%, respectively. The AUC of FIB-4 and APRI in predicting advanced liver fibrosis (F3) were 0.748 (0.661-0.822) and 0.745 (0.658-0.819), it was not significantly related with GPR ( P >0.05). Conclusion GPR, FIB-4 and APRI had moderate predictive value in predicting progressive liver fibrosis (F3) of CHB combined with NAFLD, but no significant value in predicting significant liver fibrosis (F2). Fatty liver may affect the value of noninvasive serological diagnosis in predicting liver fibrosis.