红细胞分布宽度与淋巴细胞比值在乙肝肝硬化中的预测作用

Predictive Value of Red Cell Distribution Width-to-Lymphocyte Ratio in Hepatitis B-Related Cirrhosis

目的:比较红细胞分布宽度与淋巴细胞比值(RLR)、γ-谷氨酰转肽酶与血小板比值(GPR)、谷草转氨酶与血小板比值(APRI)、基于4因子的纤维化指数(FIB-4)、红细胞分布宽度(RDW)在乙肝肝硬化患者中的评估价值。方法:回顾性分析2015年1月至2020年9月我院感染性疾病及肝病科、消化内科、体检中心研究对象共822例,其中健康对照组300例,慢性乙型肝炎组205例,乙肝肝硬化组317例。收集其血常规、肝功、凝血功能等实验室检测指标,比较各组RLR、APRI、GPR、FIB-4、RDW水平。绘制受试者工作特征(ROC)曲线评价各指标单独或联合检测对乙肝肝硬化的诊断价值,计算出最佳截断值。按有无消化道出血将乙肝肝硬化患者进行分组,分析RLR与血液学指标以及无创血清学模型的相关性。对乙肝肝硬化组的危险因素进行多因素回归分析。比较乙肝肝硬化组出现不同并发症时的RLR水平。结果:乙肝肝硬化组患者RDW、RLR、APRI、GPR和FIB-4水平高于慢性乙型肝炎组和健康对照组(P<0.01)。ROC曲线显示APRI、GPR、RDW、FIB-4、RLR曲线下面积分别为0.59、0.62、0.72、0.76、0.79(P<0.05)。以慢性乙型肝炎组为对照,RLR与其他无创血清学模型联合后对于乙肝肝硬化的诊断价值最高的是RLR+FIB-4,对应的曲线下面积为0.82,敏感度和特异度为68.50%、83.90%。Logistic回归模型显示,凝血酶原时间(PT)、RLR为乙肝肝硬化的独立危险因素(P<0.05)。有消化道出血、有肝性脑病的乙肝肝硬化患者的RLR值高于无消化道出血以及无肝性脑病者(P<0.01)。结论:RLR对于乙肝肝硬化的诊断价值优于单独的RDW值,APRI、GPR、FIB-4与RLR联合检测可提高对于乙肝肝硬化的诊断价值。

Objective:To compare the predictive value of red cell distribution width-to-lymphocyte ratio(RLR),γ-glutamyl transpeptidase and platelet ratio index(GPR),aspartate aminotransferase-to-platelet ratio index(APRI),fibrosis index based on the four factors(FIB-4)and red cell distribution width(RDW)in patients with hepatitis B-related cirrhosis.Methods:Clinical data of 822 subjects in our hospital from January 2015 to September 2020 were analyzed retrospectively,including 300 cases in the healthy control group,205 cases in the chronic hepatitis B group,and 317 cases in the hepatitis B cirrhosis group.Laboratory test indicators such as blood routine,liver function,coagulation function were collected,levels of RLR,APRI,GPR,FIB-4,RDW of each group were compared.Receiver operating characteristic(ROC)curve was drawn to evaluate each indicator individually or jointly for the diagnostic value to hepatitis B-related cirrhosis,and the best cut-off value was calculated.According to the presence or absence of gastrointestinal bleeding,patients with hepatitis B-related cirrhosis were divided into two groups,and the correlation between RLR and hematological indexes and noninvasive serological models were analyzed.Multivariate regression analysis was performed on the risk factors of hepatitis B cirrhosis group.The RLR levels in the hepatitis B cirrhosis group with different complications occurrence were compared.Results:The levels of RDW,RLR,APRI,GPR and FIB-4 of patients in the hepatitis B cirrhosis group were higher than those in the chronic hepatitis B group and the healthy control group(P<0.01).The ROC curve showed that the AUC of APRI,GPR,RDW,FIB-4,and RLR were 0.59,0.62,0.72,0.76,0.79,respectively(P<0.05).Taking the chronic hepatitis B group as the control,the highest diagnostic value for hepatitis B-related cirrhosis after RLR combined with other noninvasive serological models is RLR+FIB-4.The AUC is 0.82,and the sensitivity and specificity are 68.50%,83.90%.Logistic regression model showed that,prothrombin time(PT)and RLR were independent risk factors for hepatitis B-related liver cirrhosis(P<0.05).The RLR of hepatitis B cirrhosis patients with gastrointestinal bleeding or hepatic encephalopathy was higher than that without gastrointestinal bleeding and hepatic encephalopathy(P<0.01).Conclusion:The diagnostic value of RLR for hepatitis B-related cirrhosis is better than RDW alone.The joint detection of APRI,GPR,FIB-4 and RLR can improve the diagnostic value to hepatitis B-related cirrhosis.