血清无创方法诊断慢性乙型肝炎病毒感染者肝纤维化的效果评价

Evaluation of serum non-invasive methods for the diagnosis of liver fibrosis in patients with chronic hepatitis B virus infection

目的评价肝纤维化指数4(FIB-4)、天冬氨酸氨基转移酶/血小板比值指数(APRI)和γ谷氨酰转肽酶/血小板比值(GPR)单独应用及联合应用对HBV感染者肝纤维化的诊断价值。方法选择2017年8月至2020年8月在杭州师范大学附属医院住院治疗,并行肝脏组织活检的慢性HBV感染者275例,根据纤维化S≥2为显著肝纤维化诊断金标准,分为无显著纤维化(S0~1)组和显著纤维化(S2~4)组,比较两组中FIB-4、APRI、GPR以及FIB-4+APRI(FA)、APRI+GPR(AG)、FIB-4+GPR(FG)的检测水平差异,绘制受试者工作特征曲线(ROC),评价这几种血清无创诊断方法单独应用及联合应用诊断慢性HBV感染者显著肝纤维化的价值。结果 S0~1组的GPR、APRI、FIB-4、FA、AG、FG水平明显低于S2~4组(t=-7.85、-8.89、-9.13、-8.86、-10.27和-9.92,P均<0.001)。单独应用时,FIB-4的AUC为0.800,灵敏度90.91%,特异性58.85%,诊断效能最佳。联合应用时,FG诊断慢性HBV感染者显著肝纤维化的AUC值最高为0.840,灵敏度83.33%,特异性75.12%。结论 GPR、APRI、FIB-4、FA、AG、FG诊断进展期肝纤维化均有一定的临床价值。单独应用时,FIB-4对慢性HBV感染者显著肝纤维化诊断效能最佳,这3项指标两两组合的诊断效能更胜于单独应用,尤以FIB-4与GPR联合诊断效能最佳。

Objective To investigate the diagnostic value of single or combined application of fibrosis index based on the 4 factors(FIB-4),aminotransferase-to-platelet ratio index(APRI)and Gamma-glutamyl transpeptidase to platelet ratio(GPR)for progressive liver fibrosis in patients with chronic HBV infection.Methods A total of 275 patients who underwent liver biopsy in the Affiliated Hospital of Hangzhou Normal University from August 2017 to August 2020 and were diagnosed with chronic HBV infection were enrolled.According to the gold standard for the diagnosis of significant liver fibrosis as S≥2,they were divided into non-significant fibrosis(S0-1)group and significant fibrosis(S2-4)group.The levels of FIB-4,APRI,GPR,FIB-4+APRI(FA),APRI+GPR(AG)and FIB-4+GPR(FG)were analyzed between two groups.The receiver operating characteristic curve(ROC)was drawn to evaluate the value of these serum non-invasive diagnostic methods alone or combination in diagnosis of progressive liver fibrosis in chronic HBV infection.Results The levels of FIB-4,APRI,GPR,FA,AG and FG in S0-1 group were significantly lower than those in S2-4 group(t=-7.85,-8.89,-9.13,-8.86,-10.27 and-9.92,P all<0.001).For single application,it showed that FIB-4 had the best diagnostic efficiency with the AUC of 0.800,the sensitivity of 90.91%and the specificity of 58.85%.For combined application,it showed that FG had the best diagnostic efficiency with the AUC of 0.840,the sensitivity of 83.33%,and the specificity of 75.12%.Conclusions GPR,APRI,FIB-4,FA,AG and FG have the certain clinical value in the diagnosis of progressive liver fibrosis.For single use,FIB-4 has the best diagnostic efficacy in the diagnosis of progressive liver fibrosis in patients with HBV infection.However,the diagnostic efficacy of the combination is better than that of single use,especially the combination of FIB-4 and GPR.