AST/PLT比值指数与原发性胆汁性胆管炎不良预后的关系

Correlation between AST/platelet ratio index and progression to adverse outcomes in primary biliary cholangitis

目的探讨天冬氨酸氨基转移酶(AST)/血小板(PLT)比值指数(APRI)与原发性胆汁性胆管炎(PBC)患者不良预后的关系。方法回顾性分析安徽医科大学第一附属医院2008年1月至2018年5月收治的123例PBC患者的临床资料,通过Spearman秩相关分析APRI与患者肝组织学分期的关系,评估APRI、AST、1/PLT与PBC不良预后的相关性,分别绘制受试者工作特性曲线(ROC)并确定最佳截断值,选取曲线下面积(AUC)最大的指标,分析其与PBC患者预后的相关性。结果123例PBC患者中,28例出现不良预后,其中肝移植7例,肝病相关死亡21例。Spearman秩相关分析提示,APRI与PBC患者肝组织学分期秩相关系数Rs=0.552(P<0.001)。APRI、AST、1/PLT预测PBC不良预后的AUC分别为0.84(0.75~0.93)、0.76(0.66~0.86)、0.81(0.71~0.91),截断值分别为1.33、90.5U/L和0.0076×10^9/L。APRI>1.33、AST>90.5U/L、1/PLT>0.0076×10^9/L判断PBC出现不良预后的敏感性和特异性分别为85.71%、75.00%、71.43%和76.84%、81.05%、76.84%;阳性和阴性预测值分别为52.17%、53.85%、47.62%和94.81%、91.67%、90.12%;准确度分别为78.86%、79.67%、75.61%。APRI>1.33组较APRI≤1.33组生存率降低,差异有统计学意义(P<0.001)。结论APRI与PBC肝组织学分期呈正相关,基线APRI>1.33对PBC患者进展为肝移植或肝病相关死亡有一定预测价值。

Objective To explore the correlation between AST/platelet ratio index (APRI) and progression to adverse outcomes in primary biliary cholangitis (PBC).Methods The clinical data of 123 PBC patients admitted to the First Affiliated Hospital of Anhui Medical University from January 2008 to May 2018 were retrospectively analyzed.The correlation between APRI and PBC histological stage was analyzed by Spearman's rank correlation test.The correlation between APRI,AST,reciprocal of platelet count and PBC adverse outcomes was assessed emphatically.The optimal cut-off values for predicting adverse outcomes were determined by receiver operating characteristic (ROC) analysis.The index with the largest area under curve (AUC) was selected to analyze its correlation with the prognosis of PBC patients.Results In a total of 123 patients with PBC,28 had adverse outcomes,including 7 with liver transplantation and 21 with hepatic disease-related deaths.Spearman rank correlation analysis revealed a positive correlation between APRI and PBC liver histological stages ( Rs= 0.552,P <0.001).The AUC of APRI,AST and 1/PLT for predicting the PBC adverse outc omes was 0.84 (0.75~0.93),0.76 (0.66~0.86) and 0.81 (0.71~0.91),respectively.The cut-off value was 1.33,90.5 and 0.007 6×10^9 /L,respectively.The sensitivity of APRI>1.33,AST>90.5,1/PLT>0.007 6×10^9 /L for predicting PBC adverse outcomes was 85.71%,75.00% and 71.43%,respectively,and the specificity was 76.84%,81.05% and 76.84%,respectively.The positive predictive value was 52.17%,53.85% and 47.62%,respectively,and and negative predictive value was 94.81%,91.67% and 90.12%,respectively.The accuracy of prediction was 78.86%,79.67% and 75.61%,respectively.APRI>1.33 group had a significantly lower survival rate compared with APRI≤1.33 group ( P < 0.001 ).Conclusion APRI is positively correlated with histological disease progression in PBC patients.Elevated baseline APRI>1.33 is associated with an increased risk of adverse events in PBC.APRI appears to be a useful clinical assessment tool for PBC patients.