期刊文献+

四种诊断模型诊断乙型肝炎病毒携带者肝纤维化的效能分析 被引量:4

Diagnostic efficacy of four non-invasive diagnostic models in evaluating significant liver fibrosis in chronic hepatitis B virus carriers
下载PDF
导出
摘要 目的探讨应用基于4因子模型(FIB-4)、肝脏瞬时弹性探测仪(FS)、天冬氨酸氨基转移酶/丙氨酸氨基转移酶比率(AAR)和天冬氨酸氨基转移酶/血小板比值指数(APRI)诊断乙型肝炎病毒(HBV)携带者肝纤维化的效能。方法2015年7月~2017年11月我院收治的203例慢性HBV携带者,均符合《慢性乙型肝炎防治指南》中相关诊断标准。使用FS行肝硬度测定(LSM),并根据临床检测结果,获得FIB-4、APRI和AAR计算结果。常规行肝活检,行肝组织病理学检查,将≥S2定义为显著肝纤维化。应用ROC曲线分析4种指标诊断显著肝纤维化的效能。结果在203例慢性HBV携带者中,经病理学检查,诊断为S0期24例(11.8%),S1期143例(70.4%),S2期32例(15.8%),S3期3例(1.48%),S4期l例(0.5%),其中≥S2期者36例(17.7%);36例≥S2期患者FIB-4为(2.2±1.6),显著大于167例<S2期的(1.3±0.9),显著肝纤维化人群LSM、AAR和APRI均显著大于无显著肝纤维化人群【分别为(15.3±5.1)对(6.3±4.2)、(0.8±0.4)对(0.5±0.1)、(1.0±0.6)对(0.5±0.2),P<0.01】;ROC曲线分析显示,LSM诊断显著肝纤维化的AUC为0.967(95%CI 0.945~0.990),其灵敏度为94.4%,特异度为86.0%,AAR诊断的AUC为0.8(95%CI 0.821~0.966),其灵敏度为72.2%,特异度为99.4%,APRI诊断的AUC为0.884(95%CI 0.810~0.958),其灵敏度为72.2%,特异度为99.8%,FIB4诊断的AUC为0.792(95%CI 0.689~0.895),其灵敏度为69.4%,特异度为90.1%。结论应用无创诊断模型诊断HBV携带者显著性肝纤维化有一定的意义,对指导临床处理有帮助,但还需大样本多中心研究证实。 Objective To investigate the diagnostic efficacy of four non-invasive diagnostic models in evaluating significant liver fibrosis in chronic asymptomatic hepatitis B virus carriers(ASC).Methods 203 chronic ASCs were recruited in ourhospital between July 2015 and November 2017,and FIB-4 scoring systems,liver stiffness measure(LSM)by Fibroscan,aspartate aminotransferase/alanine aminotransferase ratio(AAR)and aspartate aminotransferase/platelet ratio index(APRI)were obtained.The liver biopsies were performed,and≥S2 was defined as significant liver fibrosis.The diagnostic efficacy was evaluated by area under ROC.Results Out of the 203 chronic ASCs,the liver histopathological examination showed that no liver fibrosis in 24(11.8%),S1 in 143(70.4%),S2 in 32(15.8%),S3 in 3(1.48%)and S4 in l(0.5%),with 36(17.7%)having≥S2 liver fibrosis;the FIB-4 in 36 ASCs with≥S2 was(2.2±1.6),significantly higher than(1.3±0.9)in 167 with less than S2,and the LSM,AAR and APRI scores in ASCs with significant liver fibrosis were all significant higher than in those with less than S2 liver fibrosis[(15.3±5.1)vs.(6.3±4.2),(0.8±0.4)vs.(0.5±0.1),and(1.0±0.6)vs.(0.5±0.2),P<0.01];the AUC in predicting significant liver fibrosis by LSM was 0.967(95%CI 0.945 to 0.990),with sensitivity(Se)of 94.4%and specificity(Sp)of 86.0%,and that by AAR was 0.8(95%CI 0.821 to 0.966),with Se of 72.2%and Sp of 99.4%,by APRI was 0.884(95%CI 0.810 to 0.958),with Se of 72.2%and Sp of 99.8%,and by FIB4 was 0.792(95%CI 0.689 to 0.895),with Se of 69.4%and Sp of 90.1%.Conclusions The application of the four non-invasive diagnostic model in predicting significant liver fibrosis in ASCs might help clinical managements,which warrants further multi-centre investigation.
作者 吴海义 陈建新 Wu Haiyi;Chen Jianxin(Department of Emergency,Peoples’s Hospital,Rugao 226500,Jiangsu Province,China)
出处 《实用肝脏病杂志》 CAS 2019年第6期832-835,共4页 Journal of Practical Hepatology
基金 江苏省如皋市医药卫生科技发展计划项目(编号:2017613)
关键词 乙型肝炎病毒携带者 肝纤维化 无创诊断 效能 Asymptomatic hepatitis B viral carriers Liver fibrosis Non-invasive diagnostic diagnosis Efficacy
  • 相关文献

参考文献6

二级参考文献33

  • 1Expert Panel on Liver Stiffness Measurement.Clinical Application of Transient Elastography in the Diagnosis of Liver Fibrosis:an Expert Panel Review and Opinion[J].Journal of Clinical and Translational Hepatology,2014,2(2):110-116. 被引量:4
  • 2袁利超,邵金华,郝美娜,李程,王贵萍,王泰龄,罗建文,白净,马安林.肝脏硬度测定仪FibroTouch与FibroScan和肝脏病理分期的相关性[J].中华肝脏病杂志,2014,22(6). 被引量:44
  • 3World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection.(2015.03).http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/.
  • 4Minakari M,Molaei M,Shalmani HM,et al.Liver steatosis in patients with chronic hepatitis B infection:host and viral risk factors. Eur J Gastroenterol Hepatol,2009,21(5):512-516.
  • 5Obara N,Ueno Y,Fukushima K,et al.Transient elastography for measurement of liver stiffness measurement can detect early significant hepatic fibrosis in Japanese patients with viral and nonviral liver diseases. J Gastroenterol,2008,43(9):720-728.
  • 6Shin WG,Park SH,Jang MK,et al. Aspartate aminotransferase to platelet ratio index(APRI) can predict liver fibrosis in chronic hepatitis B.Dig Liver Dis,2008,40(4):267-274.
  • 7Basar O,Yimaz B,Ekiz F,et al. Non-invasive tests in prediction of liver fibrosis in chronic hepatitis B andcomparison with post-antiviral treatment results. Clin Res Hepatol Gastroenterol,2013,37(2):152-158.
  • 8Wai CT,Greenson JK,Fontana RJ,et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology,2003,38(2):518-526.
  • 9Sterling RK,Lissen E,Clumeck N,et al. Development of a simple noninvasive index to predict significant fibrosisin patients with HIV/HCV coinfection.Hepatology,2006,43(6):1317-1325.
  • 10Forns X,Ampurdanes S,Llovet JM,et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model.Hepatology,2002,36(4):986-992.

共引文献14692

同被引文献56

引证文献4

二级引证文献13

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部