肝纤维化指标在乙型肝炎肝硬化及进展程度中的意义

Significance of liver fibrosis indexes in hepatitis B liver cirrhosis and its progression

目的应用Logistic模型联合受试者工作特征曲线(ROC)分析方法,评价肝纤维化指标Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(CⅣ)、透明质酸(HA)、层黏连蛋白(LN),血小板比率指数(APRI),天门冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)比值在乙型肝炎肝硬化患者诊断中的价值,并对其严重程度进行预测。方法选取2018年3月-2020年4月在太原市第三人民医院进行治疗的慢性乙型肝炎、肝硬化代偿期以及肝硬化失代偿期患者各100例、92例、90例,分析肝纤维化四项(肝纤四项)、APRI、AST/ALT指标水平对肝硬化及其分期的诊断价值。结果三组患者的肝纤维化四项、APRI水平比较差异有统计学意义(P<0.05),随着病情的发展而升高。二分类Logistic回归分析得到Logistic回归模型:Logit(P)=1/[1+EXP-1.479+0.048CⅣ+0.039HA-0.357PⅢP-0.044LN+0.097APRI+0.533AST/ALT],该模型经过似然比检验(χ^(2)=12.160,P=0.125),提示模型拟合良好,该模型诊断准确率为91.4%。ROC曲线结果显示,对于诊断肝硬化代偿期肝纤四项联合APRI,AST/ALT检测的诊断效能(AUC=0.871、灵敏度为78.33%、特异性为90.00%)高于各项指标单独检测;对于诊断肝硬化失代偿期,肝纤四项联合APRI,AST/ALT检测的诊断效能(AUC=0.937、灵敏度为88.89%、特异性为92.00%)均高于各项指标单独检测。结论实验室指标肝纤四项、APRI,AST/ALT检测在肝硬化代偿期及失代偿期的评估中有一定的价值,且联合检测的评估效能高于单一指标检测,为临床肝硬化分期的诊断可提供参考,对乙型肝炎肝硬化的进展程度有一定的预测意义。

OBJECTIVE To evaluate the value of liver fibrosis indexes typeⅢprocollagen peptide(PⅢP),typeⅣcollagen(CⅣ),hyaluronic acid(HA),laminin(LN),platelet ratio index(APRI),aspartate aminotransferase(AST)/alanine(ALT)ratio diagnosis of the patients with hepatitis B liver cirrhosis by using logistic model combined with ROC curve.METHODS A total of 100patients with chronic hepatitis B,92patients with compensated stage of cirrhosis and 90patients with decompensated stage of cirrhosis who were treated in the Third People′s Hospital of Taiyuan from Mar 2018to Apr 2020were enrolled in the study.The value of four items of serum liver fibrosis,APRI and AST/ALT in diagnosis of liver cirrhosis and its stage was observed.RESULTS There were significant differences in the levels of four items of liver fibrosis and APRI among the three groups of patients(P<0.05),and the levels of above indexes were elevated with the progression of illness condition.Logistic regression model was obtained through binomial logistic regression analysis:Logit(P)=1/[1+EXP-1.479+0.048CⅣ+0.039HA-0.357PⅢP-0.044LN+0.097APRI+0.533AST/ALT],the model was tested by likelihood ratio(χ^(2)=12.160,P=0.125),which indicated that the fitting of the model was good,and the accurate rate of the model was 91.4%in diagnosis.ROC curve analysis showed that the efficiency of the four items of serum liver fibrosis combined with APRI,AST/ALT(AUC=0.871;the sensitivity 78.33%;the specificity 90.00%)was significantly higher than that of the single index in diagnosis of compensated stage of cirrhosis;the efficiency of the four items of serum liver fibrosis combined with APRI,AST/ALT(AUC=0.937;the sensitivityc2ʍ88.89%;the specificity 92.00%)was significantly higher than that of the single index in diagnosis of decompensated stage of cirrhosis.CONCLUSION The laboratory indexes four items of serum liver fibrosis,APRI and AST/ALT show certain value in assessment of compensated stage of cirrhosis and decompensated stage of cirrhosis,and the assessment efficiency of the joint detection is higher than that of the single detection,which provides reference for diagnosis of clinical stage of liver cirrhosis and has certain significance in prediction of progression of liver cirrhosis.