5种血清无创模型对慢性乙型肝炎肝纤维化分期诊断价值的比较

Value of five noninvasive serum models in the diagnosis of chronic hepatitis B liver fibrosis

目的评价AST/PLT比值指数(APRI)、纤维化评分(FIB-4)、GGT与PLT比值(GPR)、哥德堡大学肝硬化指数(GUCI)评分和King’s评分对慢性乙型肝炎(CHB)患者肝纤维化分期的诊断价值。方法选取2016年1月—2018年12月于上海市公共卫生临床中心肝胆内科住院期间接受肝组织活检及常规实验室检查的CHB患者612例。依据Scheuer方法进行炎症分级(G)和纤维化分期(S),并依据临床指标分别计算APRI、FIB-4、GPR、GUCI评分和King’s评分。符合正态分布的计量资料两组间比较采用t检验,非正态分布计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ^(2)检验。两变量间相关性应用Spearman相关分析。采用受试者工作特征曲线下面积(AUC)比较诊断性能。结果GPR、APRI、FIB-4、King’s评分和GUCI评分在S1~2与S3~4组间比较差异均有统计学意义(Z值分别为8.683、7.372、6.294、7.204和7.795,P值均<0.001)。GPR、APRI、FIB-4、King’s评分和GUCI评分与肝纤维化分期均呈正相关(r值分别是0.54、0.48、0.44、0.48、0.49,P值均<0.001)。GPR诊断≥S2、≥S3和S4的AUC分别为0.76、0.80和0.82;APRI诊断≥S2、≥S3和S4的AUC分别为0.75、0.75和0.74;FIB-4诊断≥S2、≥S3和S4的AUC分别为0.70、0.75和0.78;King’s评分诊断≥S2、≥S3和S4的AUC分别为0.74、0.76和0.77;GUCI评分诊断≥S2、≥S3和S4的AUC分别为0.75、0.76和0.76。结论相较于APRI、FIB-4、GUCI评分和King’s评分,GPR对CHB肝纤维化分期的诊断效能最佳。

Objective To investigate the value of aspartate aminotransferase-to-platelet count ratio index(APRI),fibrosis-4(FIB-4)score,gamma-glutamyl transpeptidase-to-platelet ratio(GPR),Goteborg University Cirrhosis Index(GUCI)score,and King’s score in assessing liver fibrosis stage in patients with chronic hepatitis B(CHB).Methods A total of 612 patients with CHB who were hospitalized in Department of Hepatobiliary Medicine,Shanghai Public Health Clinical Center,from January 2016 to December 2018 and underwent liver biopsy and routine laboratory examinations were enrolled.The Scheuer method was used to determine inflammation grade(G)and fibrosis stage(S),and related clinical indicators were used to calculate APRI,FIB-4,GPR,GUCI score,and King’s score.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.A Spearman correlation analysis was used to investigate the correlation between two variables,and the area under the ROC curve(AUC)was used to compare diagnostic performance.Results There were significant differences in GPR,APRI,FIB-4,King’s score,and GUCI score between the patients with S1-S2 fibrosis and those with S3-S4 fibrosis(Z=8.683,7.372,6.294,7.204,and 7.795,all P<0.001).GPR,APRI,FIB-4,King’s score,and GUCI score were all positively correlated with liver fibrosis stage(r=0.54,0.48,0.44,0.48,and 0.49,all P<0.001).In the diagnosis of≥S2,≥S3,and S4 liver fibrosis,GPR had AUCs of 0.76,0.80,and 0.82,respectively;APRI had AUCs of 0.75,0.75,and 0.74,respectively;FIB-4 had AUCs of 0.70,0.75 and 0.78,respectively;King’s score had AUCs of 0.74,0.76,and 0.77,respectively;GUCI had AUCs of 0.75,0.76,and 0.76,respectively.Conclusion Among these five noninvasive models,GPR has the best diagnostic performance in determining liver fibrosis stage in patients with CHB.