瞬时弹性成像技术和血清无创预测模型对慢性药物性肝损伤患者肝纤维化的预测价值

The predictive value of transient elastography and serum non-invasive diagnostic models for liver fibrosis in patients with chronic drug-induced liver injury

目的探讨瞬时弹性成像技术(TE)、APRI、FIB-4、Sheth指数、GUCI评分、GPR、King′s评分对慢性药物性肝损伤患者肝纤维化的诊断价值。方法选取2020年9月至2023年7月于首都医科大学附属北京佑安医院收治并行肝穿刺活检的慢性药物性肝损伤患者。应用TE测量LSM值,按照公式计算APRI、FIB-4、Sheth指数、GUCI评分、GPR、King′s评分,绘制受试者工作特征曲线,计算曲线下面积(AUC)、敏感度、特异度、阳性预测值、阴性预测值。评估各模型的诊断价值。结果63例患者中,S0-111例,S230例,S3-422例。3组患者除GPR为0.98(0.43,1.39)比1.18(0.63,3.06)比1.28(0.85,2.48),差异无统计学意义(P=0.478)外,LSM[5.4(5.0,7.4)比14.7(9.55,39.6)比21.3(13.7,33.8),P=0.016]、APRI[0.57(0.31,1.64)比1.70(0.67,3.20)比1.35(0.82,2.60),P=0.048]、FIB-4[1.19(0.90,3.00)比3.02(1.92,6.46)比4.39(2.61,7.24),P=0.002]、Sheth指数[0.75(0.52,0.91)比1.04(0.68,2.02)比1.32(0.96,2.15),P=0.009]、GUCI评分[0.56(0.32,1.76)比1.67(0.70,3.13)比1.39(0.87,3.10),P=0.043]、King′s评分[10.36(6.46,25.40)比34.12(14.03,67.39)比34.82(13.96,76.65),P=0.022],差异均有统计学意义。Sheth指数诊断S≥2的ROC曲线下面积最大为0.848(95%CI:0.723~0.973),截断值为1.13,敏感度为0.68,特异度为1;其次为LSM,AUC为0.817(95%CI:0.631~1.003),敏感度为0.844,特异度为0.857。FIB-4、CUCI评分、King′s评分的AUC均大于0.7。LSM诊断进展期肝纤维化(S≥3)AUC为0.728(95%CI:0.568~0.887),其余指标均<0.7。结论相较于LSM、APRI、FIB-4、GUCI评分、GPR、King′s评分,Sheth指数对显著肝纤维化(S≥2)的诊断效能最佳。

Objective To explore the diagnostic value of transient elastography and serum non-invasive models including APRI,FIB-4,Sheth index,GUCI score,GPR,and King′s score in assessing liver fibrosis in patients with chronic drug-induced liver injury.Methods From September 2020 to July 2023,a total of sixty-three patients with chronic drug-induced liver injury who underwent liver biopsy at Beijing You′an Hospital of Capital Medical University were included in the study.LSM values were measured using ultrasonic transient elastography,and APRI,FIB-4,Sheth index,GUCI score,GPR,and King′s score were calculated according to the formulas.Receiver operating characteristic(ROC)curves were plotted to evaluate the diagnostic value of each model by calculating the areas under the curves(AUC),sensitivities,specificities,positive predictive values,and negative predictive values.Results Within the 63 patients that were included in this study,11 patients were pathologically with stage S0-1 of liver fibrosis,30 with S2,and 22 with S3-4.Except for GPR values[0.98(0.43~1.39)vs.1.18(0.63~3.06)vs.1.28(0.85~2.48),P=0.478]that were not significantly different among the three groups of patients(i.e.,S0-1 vs.S2 vs.S3-4),there were differences in LSM values[5.4(5.0~7.4)vs.14.7(9.55~39.6)vs.21.3(13.7~33.8),P=0.016],APRI[0.57(0.31~1.64)vs.1.70(0.67~3.20)vs.1.35(0.82~2.60),P=0.048],FIB-4[1.19(0.90~3.00)vs.3.02(1.92~6.46)vs.4.39(2.61~7.24),P=0.002],Sheth index[0.75(0.52~0.91)vs.1.04(0.68~2.02)vs.1.32(0.96~2.15),P=0.009],GUCI score[0.56(0.32~1.76)vs.1.67(0.70~3.13)vs.1.39(0.87~3.10),P=0.043],and King′s score[10.36(6.46~25.40)vs.34.12(14.03~67.39)vs.34.82(13.96~76.65),P=0.022].The ROC curve of Sheth index had the largest AUC(AUC=0.848,95%CI=0.723~0.973)and a cutoff value of 1.13 for diagnosing liver fibrosis of S≥2,with a sensitivity of 0.68 and a specificity of 1.Secondly,the AUC of LSM was 0.817(95%CI=0.631~1.003),the sensitivity was 0.844,and the specificity was 0.857.The AUC of FIB-4,GUCI score,and King′s score were all larger than 0.7.The AUC of LSM for diagnosing S≥3 liver fibrosis was 0.728(95%CI=0.568~0.887),and that of the other indicators was<0.7.Conclusion Compared with transient elastography,APRI,FIB-4,GUCI score,GPR and King′s score,the Sheth index has the best diagnostic value for significant liver fibrosis(S≥2).