GP模型对ALT小于2倍正常值上限的慢性HBV感染者肝纤维化的诊断价值

Value of globulin-platelet model in diagnosis of liver fibrosis in patients with chronic hepatitis B virus infection and alanine aminotransferase<2×upper limit of normal

目的探讨GP模型对ALT<2倍正常值上限(ULN)的慢性HBV感染者肝纤维化程度的诊断价值。方法回顾性分析2010年1月-2018年12月在安徽医科大学第二附属医院接受肝穿刺活组织检查且ALT<2×ULN的659例慢性HBV感染患者的临床资料。根据肝穿刺病理将患者的肝纤维化程度分为显著肝纤维化(≥S2)、严重肝纤维化(≥S3)和肝硬化(S4),通过患者球蛋白(Glb)、PLT计算GP模型值,应用受试者工作特征曲线(ROC曲线)评估GP模型诊断肝纤维化程度的临床价值,并与经典的APRI评分和FIB-4指数比较。计量资料符合正态分布的多组间比较采用方差分析,不符合正态分布的多组间比较采用Kruskal-Wallis H秩和检验;计数资料多组间比较采用χ2检验。采用Spearman相关分析评估无创模型与肝纤维化分期的相关性。结果GP模型值在不同肝纤维化程度的患者间差异显著(χ2=126.960,P<0.001)。随着肝纤维化程度的加重,GP模型值逐渐升高,GP模型与肝纤维化程度呈显著正相关(r=0.401,P<0.01)。Glb、APRI评分、FIB-4指数均与肝纤维化分期呈显著正相关(r值分别为0.125、0.452、0.414,P值均<0.01);PLT与肝纤维化分期呈显著负相关(r=-0.390,P<0.001)。GP模型诊断显著肝纤维化、严重肝纤维化、肝硬化的ROC曲线下面积分别为0.709、0.769、0.834,与APRI评分(0.739、0.781、0.824)和FIB-4指数(0.715、0.773、0.824)相比,差异均无统计学意义(P值均>0.05)。结论对ALT<2×ULN的慢性HBV感染者,GP模型是一种简单、准确的肝纤维化无创评估模型,与APRI评分和FIB-4指数具有相同的临床价值。

Objective To investigate the value of globulin-platelet(GP)model in the diagnosis of liver fibrosis in patients with chronic hepatitis B virus(HBV)infection and alanine aminotransferase(ALT)<2×upper limit of normal(ULN).Methods A retrospective analysis was performed for the clinical data of 659 patients with chronic HBV infection who underwent liver biopsy in The Second Affiliated Hospital of Anhui Medical University from January 2010 to December 2018 and had an ALT level of<2×ULN.Based on the results of liver biopsy,the patients were divided into marked liver fibrosis(S≥2)group,severe liver fibrosis(S≥3)group,and liver cirrhosis(S4)group.The levels of globulin and platelets were measured to calculate the value of GP model,the receiver operating characteristic(ROC)curve was used to evaluate the clinical value of GP model in the diagnosis of liver fibrosis,and the GP model was compared with aspartate aminotransferase to platelet ratio index(APRI)and fibrosis-4(FIB-4).An analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups;the chi-square test was used for comparison of categorical data between multiple groups;a Spearman correlation analysis was used to investigate the correlation between noninvasive models and liver fibrosis stage.Results There was a significant difference in the value of GP model between the patients with different degrees of liver fibrosis(χ2=126.960,P<0.001).The value of GP model gradually increased with the aggravation of liver fibrosis,suggesting that the value of GP model was positively correlated with the degree of liver fibrosis(r=0.401,P<0.01).Globulin,APRI score,and FIB-4 index were positively correlated with the degree of liver fibrosis(r=0.125,0.452,and 0.414,all P<0.01),and platelet was negatively correlated with the degree of liver fibrosis(r=-0.390,P<0.001).GP model had similar areas under the ROC curve to APRI score and FIB-4 index in the diagnosis of marked liver fibrosis,severe liver fibrosis,and liver cirrhosis(0.709/0.769/0.834 vs 0.739/0.781/0.824 and 0.715/0.773/0.824,all P>0.05).Conclusion For patients with chronic HBV infection and ALT<2×ULN,GP model is a simple and accurate noninvasive assessment model for liver fibrosis,with a similar clinical value to APRI score and FIB-4 index.