丙氨酸氨基转移酶≤2倍正常上限值且HBeAg阴性乙型肝炎肝纤维化无创预测模型的建立

Construction of a non-invasive model to predict liver fibrosis in HBeAg negative hepatitis B with alanine aminotransferase less than 2 upper limit of normal

目的:分析丙氨酸氨基转移酶(ALT)≤2倍正常上限值(2ULN)且HBeAg阴性的慢性乙型肝炎(CHB)肝纤维化的影响因素,并构建无创预测模型,以评估肝纤维化的严重程度。方法:回顾性分析295例ALT≤2ULN且HBeAg阴性的CHB病人的临床资料。所有病人根据肝穿刺病理结果进行肝纤维化分期,以纤维化分期S≥2作为显著肝纤维化的判别标准。其中肝纤维化轻度组(S≤1)94例,显著组(S≥2)201例。通过多因素logistic回归分析,筛选影响肝纤维化的独立预测因素并构建无创模型,最后通过受试者工作特征曲线下对该模型进行验证,以识别肝纤维化的严重程度。结果:多因素logistic回归分析显示,天门冬氨酸氨基转移酶、乙肝核心抗体升高可能是肝纤维化的独立预测因素(P<0.01)。该模型的AUC为0.721(95%CI:0.660~0.782,P<0.01),诊断显著肝纤维化的敏感性为60.0%,特异性为74.5%。结论:基于天门冬氨酸氨基转移酶、乙肝核心抗体两项指标构建的无创预测模型对评估CHB肝纤维化的严重程度具有较高的诊断价值。

Objective:To evaluate influencing factors of liver fibrosis in HBeAg negative hepatitis B with alanine aminotransferase(ALT)less than 2 upper limit of normal(ULN)and establish the non-invasive prediction model to assess the severity of liver fibrosis.Methods:The clinical data of 295 patients in HBeAg negative CHB patients with ALT≤2ULN were retrospectively analyzed.The degree of liver fibrosis S≥2 was taken as the discriminant criterion for significant liver fibrosis according to the pathological results of liver puncture.There were 94 cases in the mild group of liver fibrosis(S≤1)and 201 cases in the significant group(S≥2).The independent predictors of liver fibrosis were screened by multivariate logistic regression analysis and non-invasive model was constructed.Finally,the model was evaluated by area under the receiver operating characteristic curve to identify the severity of liver fibrosis.Results:Multivariate logistic regression analysis showed that aspartate aminotransferase and hepatitis B core antibody were the independent predictors of liver fibrosis(P<0.01).The AUC of this model was 0.721(95%CI:0.660-0.782,P<0.01).The sensitivity and specificity for the diagnosis of significant liver fibrosis were 60.0% and 74.5%.Conclusions:The non-invasive prediction model based on the two indicators of aspartate aminotransferase and hepatitis B core antibody has high diagnostic value for evaluating the severity of liver fibrosis in CHB.