γ-谷氨酰转肽酶/胆碱酯酶比值预测慢性乙型肝炎患者肝纤维化程度的效能评价

Diagnostic value of gamma-glutamyl transpeptidase to cholinesterase ratio in predicting hepatic fibrosis in patients with chronic hepatitis B

目的评价γ-谷氨酰转肽酶/胆碱酯酶比值(GCR)与γ-谷氨酰转肽酶/血小板比值(GPR)预测慢性乙型肝炎(CHB)患者肝纤维化程度的效能。方法本研究纳入1335例HBeAg阳性和1026例HBeAg阴性CHB患者。采用Scheuer评分系统评估肝组织纤维化程度,将肝纤维化分期≥S2和=S4分别定义为显著纤维化和肝硬化。结果在HBeAg阳性患者中,发现886例显著肝纤维化,286例肝硬化,在HBeAg阴性患者中,发现556例显著肝纤维化,202例肝硬化;在HBeAg阳性患者,GCR预测显著纤维化的ROC曲线下面积(AUC)为0.770(95%CI:0.747~0.793),显著大于GPR预测【0.757(0.733~0.780),P<0.05】,GCR预测肝硬化的AUC为0.816(95%CI:0.794~0.837),接近GPR预测【0.808(0.786~0.829)】;在HBeAg阴性患者,GCR预测显著纤维化的AUC为0.761(95%CI:0.733~0.787),接近GPR预测【0.758(0.731~0.784)】,GCR预测肝硬化的AUC为0.838(95%CI:0.814~0.860),接近GPR预测【0.829(0.804~0.851)】;以GCR>0.100和GPR>0.500为截断点,预测HBeAg阳性患者显著纤维化的特异度为81.5%和80.6%,预测HBeAg阴性患者显著纤维化的特异度为81.5%和79.4%,预测HBeAg阳性患者肝硬化的灵敏度为84.3%和81.5%,预测HBeAg阴性患者肝硬化的灵敏度为79.2%和82.7%。结论无论在HBeAg阳性和阴性CHB患者,GCR预测显著纤维化和肝硬化的效能高于或接近GPR。

Objective The purpose of this study was to evaluate the diagnostic value of gamma-glutamyl transpeptidase to cholinesterase ratio(GCR)in predicting hepatic fibrosis in patients with chronic hepatitis B(CHB).Methods 1335 HBeAg-positive and 1026 HBeAg-negative patients were enrolled in this study.The liver histological assessment by Scheuer scoring system was done,and the fibrotic staging≥S2 and=S4 were defined as significant fibrosis and cirrhosis,respectively.Results Out of serum HBeAg positive patients,886 cases were found to have significant fibrosis and 286 cases were having liver cirrhosis,and out of serum HBeAg negative patients,556 cases having significant fibrosis and 202 having cirrhosis;in HBeAg-positive patients,the area under ROC curve(AUC)by GCR in predicting significant fibrosis was 0.770(95%CI:0.747-0.793),significantly greater than[0.757(95%CI:0.733-0.780)by gamma-glutamyltranspeptidase to platelet ratio(GPR,P<0.05),and in predicting cirrhosis was 0.816(95%CI:0.794-0.837),which was close to that by GPR[0.808(95%CI:0.786-0.829)];in HBeAg-negative patients,the AUC by GCR in predicting significant fibrosis was 0.761(95%CI:0.733-0.787),which was close to that by GPR[0.758(95%CI:0.731-0.784),and in predicting cirrhosis was 0.838(95%CI:0.814-0.860),which was also close to that by GPR[0.829(95%CI:0.804-0.851)];we set the GCR>0.100 and GPR>0.500 as the cut-off-value,the specificities in predicting significant fibrosis in HBeAg-positive patients were 81.5%and 80.6%,and in HBeAg-negative patients were 81.5%and 79.4%,respectively;the sensitivities in predicting cirrhosis in HBeAg-positive patients were 84.3%and 81.5%,and in HBeAg-negative patients were 79.2%and 82.7%,respectively.Conclusion The diagnostc performance of GCR in predicting significant fibrosis and cirrhosis in patients with CHB is higher than or close to that by GPR,which needs further investigation.