丙氨酸转氨酶低于正常值上限的慢性HBV感染者肝纤维化无创模型的构建

A noninvasive model to predict liver fibrosis in chronic hepatitis B patients with ALT less than upper limit of normal level

目的探索丙氨酸转氨酶(ALT)低于正常值上限的慢性HBV感染者肝纤维化程度的预测因素,建立一个新的无创评估模型并验证其诊断价值。方法收集2014年1月至2017年9月温州医科大学附属第一医院感染科收治的183例ALT<40 U/L的慢性HBV感染者的临床资料。根据Ishak评分系统,将患者分为非显著肝纤维化组149例(F0~F2期)和显著肝纤维化组34例(F3~F6期)。回顾性分析患者的临床资料、肝脏硬度测量(LSM)、肝脏超声、肝脏生化学指标及HBV血清学指标等。采用多因素Logistic回归分析影响肝组织发生明显纤维化的指标,并构建预测肝纤维化新的模型。采用受试者工作特征(ROC)曲线比较新模型与其他无创肝纤维化模型的诊断价值。结果多因素Logistic回归分析显示,LSM(OR=1.327,95%CI 1.149~1.531)、超声评分(OR=6.610,95%CI 2.704~16.156)是ALT低于正常值上限的慢性HBV感染者肝纤维化的独立预测因素;预测肝纤维化新的模型(LU)ROC曲线下面积均大于超声评分、LSM、FIB-4、APRI和GPR(AUC=0.790、0.804、0.654、0.673和0.770),差异均有统计学意义(Z=3.394、1.982、2.077、3.168和2.165,P<0.05或<0.01);LU的敏感度和特异度分别为85.3%和77.2%。结论LU模型对诊断ALT低于正常值上限的慢性HBV感染者的肝纤维化程度有较好的预测价值。

Objective To establish a noninvasive prediction model for liver fibrosis in chronic hepatitis B(CHB)virus infection patients with alanine aminotransferase(ALT)less than upper limit of normal level.Methods A total of 183 CHB patients with ALT<40 U/L admitted in the First Affiliated of Wenzhou Medical University from January 2014 to September 2017 were enrolled.There were 149 cases of non-marked liver fibrosis(F0-F2)and 34 cases of marked liver fibrosis(F3-F6)according to the Ishak scoring system.The clinical data,liver stiffness measurement(LSM),liver ultrasound imaging,serum biochemical features and hepatitis B virus related indexes of patients were retrospectively analyzed.The independent predictors of liver fibrosis were screened and a prediction model was constructed based on the results of multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was applied to evaluate the established model and other indicators in predicting liver fibrosis.Results Multivariate logistic regression analysis showed that LSM(OR=1.327,95%CI 1.149-1.531),liver ultrasound scores(OR=6.610,95%CI 2.704-16.156)were independent predictors of liver fibrosis.The area under ROC curve(AUC)of the established model(LU)in predicting liver fibrosis was 0.873(95%CI 0.799-0.947),which was significantly greater than that of the ultrasound score,LSM,FIB-4,APRI and GPR(AUC=0.790,0.804,0.654,0.673 and 0.770;Z=3.394,1.982,2.077,3.168 and 2.165,all P<0.05 or<0.01).With the cut-off value of-1.787,the sensitivity and specificity of LU model were 85.3%and 77.2%,respectively.Conclusion The established model(LU)can effectively predict the liver fibrosis in CHB patients with ALT less than upper limit of normal.