8种血清学诊断模型对年龄小于30岁的ALT水平正常的CHB患者肝纤维化诊断价值

Diagnostic value of 8 serological diagnostic models for the diagnosis of hepatic fibrosis in CHB patients under 30 years of age with normal ALT levels

目的对比8种血清学诊断模型对年龄≤30岁的ALT正常的慢性乙型肝炎(chronic hepatitis B,CHB)患者肝纤维化分期诊断效能,选择更为便捷有效的诊断预测模型,为该类人群提供早期抗病毒治疗的时机。方法选取2015年1月—2020年12月在解放军总医院第五医学中心北院区行肝穿刺活检术的104例年龄≤30岁的ALT水平正常的CHB患者,采用天冬氨酸氨基转移酶与血小板比率指数(aspartate aminotransferase to platelat ratio index,APRI)、肝纤维化4因子指数(fibrosis 4 score,FIB-4)、谷氨酰转移酶/血小板比值模型(gamma-glutamyltranspeptidase to platelet ratio,GPR)、AST/ALT比值模型(ratio of serum aspartate to alanine aminotransferase,AAR)、纤维化硬化指数模型(fibrosis cirrhosis index,FCI)、球蛋白-血小板模型(globulin-platelet model,GP)、红细胞体积分布宽度与血小板比值模型(red cell distribution width to platelet ratio,RPR)及S指数模型(S-index)的ROC曲线评估各模型对肝纤维化分期诊断的价值。结果诊断肝纤维化分期≥S1 AUC由高到低依次是FIB-4、RPR、APRI、S-index、GPR、GP、AAR及FCI;诊断肝纤维化分期≥S2 AUC由高到低依次是RPR、S-index、GPR、FIB-4、APRI、AAR、FCI及GP;诊断肝纤维化分期≥S3 AUC由高到低依次是RPR、S-index、FCI、GPR、FIB-4、GP、APRI及ARR。结论RPR及S-index对肝纤维化分期有较好的诊断效能,其中RPR诊断效能最佳。

Objective To compare the diagnostic efficacy of eight serological diagnostic models for the staging of liver fibrosis in chronic hepatitis B(CHB)patients with normal ALT aged≤30 years,and to select a more convenient and effective diagnostic prediction model to provide early antiviral treatment for this population.Methods A total of 104 CHB patients with normal ALT aged≤30 years who underwent hepatic puncture biopsy at the North Campus of Fifth Medical Center of Chinese PLA General Hospital from January 2015 to December 2020 were selected,evaluating the value of each model for the diagnosis of hepatic fibrosis staging by using the subject operating characteristic(ROC)curves of aspartate aminotransferase to platelat ratio index(APRI),fibrosis 4 score(FIB-4),gamma-glutamyltranspeptidase to platelet ratio(GPR),ratio of serum aspartate to alanine aminotransferase(AAR),fibrosis cirrhosis index(FCI),globulin-platelet model(GP),red cell distribution width to platelet ratio(RPR),and S-index models.Results The AUC of diagnosing liver fiber stage≥S1 from high to low was FIB-4,RPR,APRI,S-index,GPR,GP,AAR and FCI.The AUC of diagnosing liver fiber stage≥S2 from high to low was RPR,S-index,GPR,FIB-4,APRI,AAR,FCI and GP.The AUC for the diagnosis of≥S3 liver fibrosis was RPR,S-index,FCI,GPR,FIB-4,GP,APRI and ARR in descending order.Conclusion RPR and S-index have good diagnostic performance for liver fibrosis staging,with RPR having the best diagnostic performance.