7种无创诊断模型对慢性乙型肝炎肝纤维化及肝硬化的诊断价值评估

Diagnostic value assessment of seven noninvasive diagnostic models in liver fibrosis and cirrhosis of patients with chronic hepatitis B

目的探讨谷草转氨酶/血小板比值(APRI)、肝硬化判别式值(CDS)、基于4因子的纤维化指数(FIB-4)、Forns指数、谷氨酰转移酶/血小板比值(GPR)、King’s评分、S指数模型对慢性乙型肝炎(CHB)患者肝纤维化及肝硬化的诊断价值。方法选取2019年1月至2020年12月上海中医药大学附属普陀医院收治并行肝穿刺活检与血液生化凝血等指标检测的166例CHB患者。根据肝活检结果的肝纤维化分期(S)进行分组:无明显肝纤维化组(S0~1)55例,显著肝纤维化组(S2~3)97例,早期肝硬化组(S4)14例。按照公式计算APRI、CDS、FIB-4、Forns指数、GPR、King’s评分、S指数,同时绘制上述7种模型的受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)、灵敏度及特异度,评估各模型对肝纤维化诊断的价值。结果三组模型评分比较,差异有高度统计学意义(P<0.01)。除CDS模型外,各模型指数与炎症分级呈正相关(r>0,P<0.05);各模型评分结果与肝纤维化分期呈正相关(r>0,P<0.05)。S指数、APRI、GPR、King’s评分诊断显著肝纤维化的AUC>0.7。诊断早期肝硬化的AUC由高到低依次是GPR、S指数、APRI、Forns指数、King’s评分、CDS、FIB-4。7种模型AUC分析显示,显著肝纤维化组APRI与King’s评分差异有统计学意义(Z=2.197,P<0.05);其他各模型间比较,差异无统计学意义(P>0.05)。结论APRI、GPR、King’s评分、S指数均能较好地诊断CHB患者显著肝纤维化与早期肝硬化。CDS、FIB-4、Forns指数对早期肝硬化有一定诊断价值而对于显著肝纤维化的诊断准确率较低。APRI和GPR模型计算简单,血清学指标容易获得,费用低,可推荐为在基层及医疗资源有限地区CHB患者肝纤维化的检测方法,使部分患者避免有创肝穿刺活检,减少医疗费用。

Objective To explore the diagnostic value of liver fibrosis and cirrhosis in patients with chronic hepatitis B(CHB) among the aspartate aminotransferase/platelet ratio(APRI), cirrhosis discriminant score(CDS), and fibrosis index based on the four factors(FIB-4), Forns index, glutamyltransferase/platelet ratio(GPR), King’s score, S index model for chronic. Methods From January 2019 to December 2020, a total of 166 patients with CHB who were admitted to Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and underwent liver biopsy and blood biochemical coagulation tests were selected. According to the liver fibrosis stage(S) of the liver biopsy results, there were 55 cases in the non-obvious liver fibrosis group(S0-1), 97 cases in the significant liver fibrosis group(S2-3), and14 cases in the early-stage cirrhosis group(S4). The APRI, CDS, FIB-4, Forns index, GPR, King’s score, and S index according to the formula were calculate. At the same time, the receiver operating characteristic(ROC) curves of the above seven models were drawn, and the area under the ROC curve(AUC), sensitivity, and specificity were calculated to evaluate the value of each model in the diagnosis of liver fibrosis. Results Compared with the three groups of model scores, and the difference was highly statistically significant(P < 0.01). Except for the CDS model, each model index was positively correlated with the inflammation grade(r > 0, P < 0.05);the scores of each model were positively correlated with liver fibrosis stage(r > 0, P < 0.05). The AUC of S index, APRI, GPR, and King’s score for the diagnosis of significant liver fibrosis>0.7. The AUC for the diagnosis of early liver cirrhosis from high to low as GPR, S index, APRI, Forns index, King’s score, CDS, and FIB-4. The AUC analysis of the seven models showed that there was a statistically significant difference between APRI and King’s score in the significant liver fibrosis group(Z = 2.197, P < 0.05);there was no significant difference between the other models(P > 0.05). Conclusion APRI,GPR, King’s score, and S index can better diagnose significant liver fibrosis and early cirrhosis in CHB patients. CDS,FIB-4, Forns index have certain diagnostic value for early liver cirrhosis, but the diagnostic accuracy for significant liver fibrosis is low. APRI and GPR models are simple to calculate, serological indicators are readily available, and the cost is low. It can be recommended as a detection method for liver fibrosis in patients with CHB in the grassroots and areas with limited medical resources, so that some patients can avoid invasive liver biopsy and reduce medical costs.