Noninvasive assessment of liver fibrosis with combined serum aminotransferase/platelet ratio index and hyaluronic acid in patients with chronic hepatitis B

AIM： To construct a noninvasive assessment model consisting of routine laboratory data to predict significant fibrosis and cirrhosis in patients with chronic hepatitis B （CHB）. METHODS： A total of 137 consecutive patients with CriB who underwent percutaneous liver biopsy were retrospectively analyzed. These patients were divided into two groups according to their aminotransferase （ALT） level. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）, the likelihood ratio （LR） of aminotransferase/platelet ratio index （APRI） ≥ 1.5 or 〈 1.5 in combination with different hyaluronic acid （HA） cut-off points were calculated for the presence of moderate to severe fibrosis/cirrhosis （fibrosis stages 2 and 4） and no to mild fibrosis/cirrhosis （fibrosis stages 0 and 1）. RESULTS： The APRI correlated with fibrosis stage in CriB patients. The APRI ≥1.5 in combination with a cut-off HA cut-off point 〉 300 ng/mL could detect moderate to severe fibrosis （stages 2-4） in Crib patients. The PPV was 93.7%, the specificity was 98.9%. The APRI 〈 1.5 in combination with different HA cut-off points could not detect no to mild fibrosis in CHB patients. CONCLUSION： The APRI ≥ 1.5 in combination with a HA cut-off point 〉 300 ng/mL can detect moderate to severe fibrosis （stages 2-4） in Crib patients.

Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B

AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse(ARFI), aspartate aminotransferase to platelet ratio index(APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B(CHB). METHODS: In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated. RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage(all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI(P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage(Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI(Z = 0.958, P = 0.338). CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.

Prediction of hepatocellular carcinoma development by aminotransferase to platelet ratio index in primary biliary cholangitis

AIM To investigate the usefulness of aspartate aminotransferase to platelet ratio index(APRI) in predicting hepatocellular carcinoma(HCC) risk in primary biliary cholangitis(PBC).METHODS We identified PBC patients between 2000 and 2015 by searching the electronic medical database of a tertiary center. The hazard ratio(HR) of HCC with different risk factors was determined by Cox proportional hazards model. RESULTS One hundred and forty-four PBC patients were recru-ited. Patients were diagnosed at a median age of 57.8 years [interquartile range(IQR): 48.7-71.5 years), and 41(28.5%) patients had cirrhosis at baseline. The median follow-up duration was 6.9 years(range: 1.0-26.3 years). Twelve patients developed HCC, with an incidence rate of 10.6 cases per 1000 patient-years. The overall 5-, 10-and 15-year cumulative incidences of HCC were 2.3% 95%CI: 0%-4.8%), 8.4%(95%CI: 1.8%-14.5%) and 21.6%(6.8%-34.1%), respectively. Older age(HR = 1.07), cirrhosis(HR = 4.38) and APRI at 1 year after treatment(APRI-r1) > 0.54(HR = 3.94) were independent factors for HCC development. APRI-r1, when combined with treatment response, further stratified HCC risk(log rank P < 0.05). The area under receiver operating curve of APRI-r1 in predicting HCC was 0.77(95%CI: 0.64-0.88).CONCLUSION APRI-r1 can be used to predict the development of HCC in PBC patients. Combination of APRI-r1 with treatment response can further stratify the HCC risk.

Diagnostic value of FIB-4, aspartate aminotransferaseto-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase

AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase(PNALT).METHODS We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase(PIALT1) group [alanine transaminase(ALT) within 1-2 × upper limit of normal value(ULN)], and 64 in PIALT2 group(ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were performed.RESULTS The pathological examination revealed moderate inflammatory necrosis ratios of 16.81%(16/95), 32.56%(28/86), and 45.31%(28/64), and moderate liverfibrosis of 24.2%(23/95), 33.72%(29/86), and 43.75%(28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group(P < 0.05). No significant difference was found in the areas under the curve(AUCs) between APRI and FIB-4 in the PNALT group; however, significant differences were found between APRI and LSM, and between FIB-4 and LSM in the PNALT group(P < 0.05 for both). In the PIALT1 and PIALT2 groups, no significant difference(P > 0.05) was found in AUCs for all comparisons(P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI(P < 0.05).CONCLUSION APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.

Novel immunological and nutritional-based prognostic index for gastric cancer

AIM: To assess the prognostic significance of immunological and nutritional-based indices, including the prognostic nutritional index(PNI), neutrophillymphocyte ratio(NLR), and platelet-lymphocyte ratio in gastric cancer.METHODS: We retrospectively reviewed 632 gastric cancer patients who underwent gastrectomy between1998 and 2008. Areas under the receiver operating characteristic curve were calculated to compare the predictive ability of the indices, together with estimating the sensitivity, specificity and agreement rate.Univariate and multivariate analyses were performed to identify risk factors for overall survival(OS). Propensity score analysis was performed to adjust variables to control for selection bias.RESULTS: Each index could predict OS in gastric cancer patients in univariate analysis, but only PNI had independent prognostic significance in multivariate analysis before and after adjustment with propensity scoring(hazard ratio, 1.668; 95% confidence interval:1.368-2.035). In subgroup analysis, a low PNI predicted a significantly shorter OS in patients with stage Ⅱ-Ⅲ disease(P = 0.019, P < 0.001), T3-T4 tumors(P <0.001), or lymph node metastasis(P < 0.001). Canton score, a combination of PNI, NLR, and platelet, was a better indicator for OS than PNI, with the largest area under the curve for 12-, 36-, 60-mo OS and overall OS(P = 0.022, P = 0.030, P < 0.001, and P = 0.024,respectively). The maximum sensitivity, specificity, and agreement rate of Canton score for predicting prognosis were 84.6%, 34.9%, and 70.1%, respectively.CONCLUSION: PNI is an independent prognostic factor for OS in gastric cancer. Canton score can be a novel preoperative prognostic index in gastric cancer.

Therapeutic Effect of Daphnetin on Mastitis Induced by Staphylococcus aureus in Mice

[Objectives]To observe the effects of daphnetin on mastitis induced by Staphylococcus aureus in mice.[Methods]18 postpartum ICR female mice were used to establish mastitis animal model,and were randomly divided into three groups(A,B,and C)with 6 mice in each group.Group A:blank control group;group B:S.Aureus model group;group C:S.Aureus model+daphnetin group.The experimental groups were injected 1 mL of 1.0×104 CFU/100μL of S.aureus of along the nipple catheter.The suspension was placed in the 3 rd and 4 th pairs of mammary glands,and the control group was injected with the same dose of normal saline.On the second day after infection,the rats in group A,B and C were given drugs by gavage,while the rats in group A and B were given normal saline and the rats in group C were given daphnetin once a day for 6 consecutive days.Blood samples were collected from living eyeballs,and blood cells were analyzed by automatic flow cytometer after anticoagulation.[Results]The NLR and Systemie Immune Inflammati-on Index(SII)in the blood of mastitis mice induced by S.aureus were significantly higher than those in the control group(P<0.01),suggesting that neutrophil to lymphocyte ratio(NLR)and SII can be used as diagnostic indicators of mastitis,and the levels of NLR and SII decreased significantly after daphnetin intervention.[Conclusions]NLR and SII showed high levels in mastitis mice,which are valuable for the diagnosis of mastitis and the evaluation of its prognosis.After the intervention of daphnetin,both of them decreased significantly,indicating that daphnetin has a good prognosis trend in mastitis mice induced by S.aureus.

蛛网膜下腔出血患者外周血NLR、LMR、PLR和SII值变化的临床意义

目的 分析动脉瘤性蛛网膜下腔出血(aSAH)对血液学参数的影响及其与患者临床状态和短期预后的关系。方法 分析2019年3月至2022年5月于四川省科学城医院神经外科治疗的62例颅内动脉瘤(IA)破裂急性期患者和55例正常对照组。采用流式细胞术分析两组患者外周血中白细胞(WBC)与淋巴细胞(LC)计数的变化,计算中性粒细胞/淋巴细胞比(NLR)、淋巴细胞/单核细胞比(LMR)、血小板/淋巴细胞比(PLR)和全身免疫-炎症指数(SII),并分析血液学参数与患者临床状况和短期预后的关系。结果 与正常对照组相比,IA破裂组WBC、中性粒细胞(Ns)计数、NLR以及SII均明显升高,而LC计数和LMR降低。此外相比于临床状态恢复良好的患者,临床状态较差的患者LC计数明显降低,而NLR、PLR和SII值明显升高。格拉斯哥昏迷评分法(GCS)评分较低的患者CD3+、CD4-、CD8-细胞比例减少。此外,LC计数降低和PLR升高与较差的短期预后相关。结论 IA破裂后会导致全身免疫和炎症反应,LC计数、NLR、PLR和SII值可以作为临床状态及预后的标志物。

外周血炎症指标动态变化对晚期肝细胞癌免疫联合抗血管治疗疗效的预测价值:基于RESCUE临床试验随访数据的分析

背景外周血炎症指标被认为是免疫治疗潜在的疗效预测标志物,但关于各指标的动态变化及联合预测效果的研究甚少。目的探讨单独和联合应用外周血炎症指标动态变化对晚期肝细胞癌(hepatocellular carcinoma,HCC)免疫联合抗血管治疗疗效的预测价值。方法选择接受卡瑞利珠单抗和甲磺酸阿帕替尼联合治疗的189例晚期HCC患者。从基线开始至末次治疗后30 d,每2周检测1次外周血,计算整个治疗过程中动态变化的外周血炎症指标,包括中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)、预后营养指数(prognostic nutritional index,PNI)和系统免疫炎症指数(systemic immune-inflammation index,SII)。在时间依存性Cox回归模型中,治疗期间随时间变化的NLR、PLR、PNI和SII分别定义为时依NLR、PLR、PNI及SII,时依均值为各指标治疗期间的平均值。根据疗效,将189例患者分为完全缓解(complete response,CR)/部分缓解(partial response,PR)组、病情稳定(stable disease,SD)组和疾病进展(progressive disease,PD)组,分析不同指标的基线值及时依均值与不同疗效的相关性。采用Kaplan-Meier法绘制生存曲线。采用单因素和多因素Cox比例风险回归模型及时间依存性Cox回归模型分析患者总生存期(overall survival,OS)的关联因素;应用一致性指数(C指数)评价各炎症指标单独及联合应用对OS的预测效能。结果189例患者中,男169例,女20例,年龄≥60岁44例。CR/PR组、SD组和PD组分别有51例、95例和38例,3组NLR[M(IQR):1.9(1.3~2.3)vs 2.2(1.6~3.2)vs 2.8(1.8~3.9),P<0.001]、PLR[M(IQR):87(67~104)vs 99(84~127)vs 131(86~179),P<0.001]和SII[M(IQR):233(166~266)vs 292(189~412)vs 376(233~695),P<0.001]时依均值的差异均有统计学意义。所有患者的中位OS为21.7个月(95%CI:18.171~25.189)。各炎症指标单独应用的多因素分析示,时依NLR、时依PLR、时依PNI和时依SII均是OS的独立关联因素(P<0.05)。随着NLR、PLR和SII值的上升,OS风险比上升;随着PNI值的上升,OS风险比下降。在所有预测模型中,时依PLR、时依PNI和时依SII三项指标的联合预测效果最好,C指数为0.750(95%CI:0.709~0.790)。结论外周血炎症指标预测晚期HCC免疫联合抗血管治疗中,低NLR、PLR、SII以及高PNI水平的患者疗效更好。与基线数据相比,整个观察期内的时依数据模型预测效果较好,其中时依PLR、时依PNI和时依SII三项指标的联合预测效果最好。

非酒精性脂肪性肝病患者C/RL-r、APRI、FIB-4水平与肝纤维化发生的相关性

目的分析非酒精性脂肪性肝病(NAFLD)患者改良肝尾状叶/右叶比值(C/RL-r)、天门冬氨酸氨基转移酶与血小板比值指数(APRI)、基于4因子的纤维化指数(FIB-4)与肝纤维化发生的相关性。方法选择2021年2月至2022年12月在保定市第一中心医院治疗的NAFLD患者153例,根据病理学结果,将患者分为无肝纤维化组81例、肝纤维化组72例。行MRI扫描检测C/RL-r;计算APRI、FIB-4水平;分析NAFLD患者实验室指标、C/RL-r、APRI、FIB-4水平与发生肝纤维化的相关性,发生肝纤维化的独立危险因素及C/RL-r、APRI、FIB-4对NAFLD患者发生肝纤维化的预测价值。结果肝纤维化组ALT、AST、TBil、GGT、TG、C/RL-r、APRI、FIB-4水平显著高于无肝纤维化组,分别为(42.32±10.21)U/L比(36.21±7.78)U/L、(45.36±8.72)U/L比(27.45±5.40)U/L、(13.52±3.65)μmol/L比(12.24±2.16)μmol/L、(60.53±13.41)U/L比(53.69±12.44)U/L、(1.99±0.53)mmol/L比(1.05±0.33)mmol/L、(1.15±0.12)比(0.92±0.09)、(0.52±0.15)比(0.32±0.10)、(1.47±0.47)比(0.94±0.30),高密度脂蛋白胆固醇(HDL-C)水平显著低于无肝纤维化组为(1.03±0.26)mmol/L比(1.32±0.45)mmol/L,(t=4.189、15.453、2.674、3.272、13.322、13.501、4.302、8.405、4.801,均P<0.05);NAFLD患者ALT、AST、TG、C/RL-r、APRI、FIB-4与发生肝纤维化呈正相关(r=0.531、0.435、0.571、0.605、0.771、0.716,均P<0.001);ALT、AST、TG、C/RL-r、APRI、FIB-4水平高是影响NAFLD患者发生肝纤维化的独立危险因素(P<0.05);C/RL-r、APRI、FIB-4、三者联合预测NAFLD患者发生肝纤维化的曲线下面积(AUC)分别为0.767、0.830、0.754、0.936;相较于C/RL-r、APRI、FIB-4单独预测的AUC,三者联合预测的AUC更高(Z=4.495、3.999、4.677,均P<0.001)。结论发生肝纤维化的NAFLD患者C/RL-r、APRI、FIB-4水平较高,三者联合检测对NAFLD患者发生肝纤维化具有较高预测价值。

基于天冬氨酸转氨酶-血小板计数比的列线图模型对肝细胞癌射频消融治疗后复发的预测价值

目的探讨天冬氨酸转氨酶-血小板计数比值指数(aspartate aminotransferase-platelet ratio index,APRI)与肝细胞癌(hepatocellular carcinoma,HCC)射频消融(radiofrequency ablation,RFA)治疗后肿瘤复发的关系。方法纳入2017年1月至2020年12月江苏大学附属武进医院初诊为HCC并接受RFA治疗的患者204例。采用受试者工作特征(receiver operation characteristics,ROC)曲线确定APRI的最佳截断值。绘制Kaplan-Meier曲线计算高、低APRI组患者的无复发生存期(recurrence-free survival,RFS)。Cox回归分析RFA后HCC复发的独立预测因素,并选择显著变量构建列线图模型。通过一致性指数(concordance index,C-index)和校正曲线评价列线图模型对HCC复发的预测能力。结果RFA治疗后HCC复发率为57.4%(117/204)。APRI预测HCC复发的最佳截断值为0.501,曲线下面积(area under curve,AUC)为0.678(95%CI:0.603~0.752)。高APRI组(≥0.501)121例,低APRI组(<0.501)83例,高APRI与患者低RFS显著相关(χ^(2)=12.929,P<0.01)。Cox回归分析证实,肿瘤数目(HR=1.541,95%CI:1.039~2.286,P=0.031)、肿瘤最大直径(HR=1.461,95%CI:1.011~2.112,P=0.044)、血清AFP(HR=2.286,95%CI:1.576~3.318,P<0.01)和APRI(HR=1.873,95%CI:1.257~2.790,P=0.002)是HCC复发的独立风险因素。基于以上4个因素构建预测RFA治疗后HCC复发的列线图模型,C-index为0.769(95%CI:0.676~0.862),预测1年、2年和3年RFS的AUC分别为0.707、0.719和0.707。校正曲线展示模型预测与实际复发风险之间具有良好一致性。结论基于APRI与肿瘤生物学特征的列线图模型对HCC复发具有良好预测能力。

AST/PLT比值指数与原发性胆汁性胆管炎不良预后的关系

目的探讨天冬氨酸氨基转移酶(AST)/血小板(PLT)比值指数(APRI)与原发性胆汁性胆管炎(PBC)患者不良预后的关系。方法回顾性分析安徽医科大学第一附属医院2008年1月至2018年5月收治的123例PBC患者的临床资料,通过Spearman秩相关分析APRI与患者肝组织学分期的关系,评估APRI、AST、1/PLT与PBC不良预后的相关性,分别绘制受试者工作特性曲线(ROC)并确定最佳截断值,选取曲线下面积(AUC)最大的指标,分析其与PBC患者预后的相关性。结果123例PBC患者中,28例出现不良预后,其中肝移植7例,肝病相关死亡21例。Spearman秩相关分析提示,APRI与PBC患者肝组织学分期秩相关系数Rs=0.552(P<0.001)。APRI、AST、1/PLT预测PBC不良预后的AUC分别为0.84(0.75~0.93)、0.76(0.66~0.86)、0.81(0.71~0.91),截断值分别为1.33、90.5U/L和0.0076×10^9/L。APRI>1.33、AST>90.5U/L、1/PLT>0.0076×10^9/L判断PBC出现不良预后的敏感性和特异性分别为85.71%、75.00%、71.43%和76.84%、81.05%、76.84%;阳性和阴性预测值分别为52.17%、53.85%、47.62%和94.81%、91.67%、90.12%;准确度分别为78.86%、79.67%、75.61%。APRI>1.33组较APRI≤1.33组生存率降低,差异有统计学意义(P<0.001)。结论APRI与PBC肝组织学分期呈正相关,基线APRI>1.33对PBC患者进展为肝移植或肝病相关死亡有一定预测价值。

NLR、PLR、SII在乙肝相关性肝癌中的表达水平及影响乙肝相关性肝癌预后的因素分析

目的分析术前中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、系统免疫炎症指数(SII)在乙肝相关性肝癌患者血液中的表达水平,探究影响乙肝相关性肝癌预后的因素。方法将2018年7月—2019年9月我院收治的乙肝相关性肝癌患者110例纳入研究组,所有患者均接受根治性手术治疗,根据术后3年内是否出现复发、转移及死亡情况,将患者分为预后不良组(42例)和预后良好组(68例)。另择同期我院收治的肝脏良性疾病手术患者128例作为对照组,回顾性收集患者临床资料。比较研究组、对照组患者术前NLR、PLR、SII表达水平;分析乙肝相关性肝癌患者预后的影响因素;绘制受试者工作特征曲线(ROC曲线)分析NLR、PLR、SII单独及三者联合检测对乙肝相关性肝癌预后不良的预测价值。结果研究组患者术前NLR、PLR、SII水平为6.92±2.16、167.90±33.21、432.52±56.22,高于对照组的3.13±0.84、110.11±24.26、326.40±20.35(t=18.310、15.465、19.898,均P<0.001)。多因素Logistic回归分析结果显示,NLR(OR=1.822,95%CI:1.295~2.563)、PLR(OR=1.037,95%CI:1.015~1.060)、SII(OR=1.007,95%CI:1.002~1.012)水平升高为乙肝相关性肝癌预后不良的危险因素(<0.05)。绘制ROC曲线结果显示,NLR、PLR、SII单独及三者联合检测预测乙肝相关性肝癌预后不良的曲线下面积(AUC)分别为0.852、0.862、0.813、0.904(均P<0.001),灵敏度分别为80.95%、85.71%、74.16%、82.10%,特异度分别为77.94%、77.94%、77.94%、95.59%。结论NLR、PLR、SII升高为乙肝相关性肝癌预后不良的危险因素;乙肝相关性肝癌患者NLR、PLR、SII单独以及三者联合检测有助于预测乙肝相关性肝癌预后。

天冬氨酸氨基转移酶与血小板比值指数与纤维化-4指数对肝癌切除术后患者预后的预测价值

目的探讨肝硬化血液生化指标天冬氨酸氨基转移酶与血小板比值指数(APRI)、纤维化-4指数(FIB-4)对肝癌切除术后患者预后的预测价值。方法回顾性收集2005年2月至2017年7月在复旦大学附属中山医院行肝癌根治性切除300例患者的临床病理资料、肝癌复发和生存情况,分析APRI、FIB-4与肝癌患者术后复发、生存的关系,应用ROC曲线评价APRI、FIB-4对肝癌切除术后患者预后的预测价值。结果300例患者的中位随访时间为61个月。单因素Cox回归分析显示,APRI、FIB-4、血管侵犯是影响肝癌患者术后无复发生存期(DFS)、总生存期(OS)的危险因素;多因素Cox回归分析显示,血管侵犯是影响肝癌患者术后DFS(HR=1.518,95%CI 1.024~2.252,P=0.038)、OS(HR=2.301,95%CI 1.270~4.167,P=0.006)的独立危险因素。时间依赖ROC(time-ROC)结果显示,APRI、FIB-4预测术后1年、3年和5年DFS的曲线下面积(AUC)为0.555~0.596,预测术后1年、3年和5年OS的AUC为0.600~0.679。结论基于血液生化检测的肝硬化指标APRI与FIB-4对肝癌患者术后预后的预测价值有限。

TBil、APRI联合GGT/Alb比值对胆道闭锁患儿肝纤维化严重程度的诊断价值

目的:探讨总胆红素(TBil)、天冬氨酸氨基转移酶/血小板比值指数(APRI)联合γ-谷氨酰转肽酶(GGT)/白蛋白(Alb)比值在诊断胆道闭锁(BA)患儿肝纤维化严重程度中的价值。方法:选取2021年9月至2023年9月于郑州大学附属儿童医院确诊且住院手术的BA患儿120例为研究对象,依据肝纤维化严重程度分为<F2期组和≥F2期组,记录患儿一般资料及临床指标。结果:≥F2期组患儿TBil、APRI、GGT/Alb比值、天冬氨酸氨基转移酶(AST)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-Col)、透明质酸(HA)、层黏蛋白(LN)显著高于<F2期组患儿(P<0.05)。BA患儿TBil、APRI、GGT/Alb比值与AST、PCⅢ、Ⅳ-Col、HA、LN均呈正相关(P<0.05)。TBil、APRI、GGT/Alb比值是BA患儿发生明显肝纤维化的独立危险因素(OR=2.939、2.873、2.895,P<0.05)。TBil、APRI、GGT/Alb比值单独及联合诊断的曲线下面积分别为0.837、0.841、0.851、0.956。结论:TBil、APRI、GGT/Alb比值联合在诊断BA患儿肝纤维化程度方面具有重要价值。

外周血炎症指标与口腔鳞状细胞癌患者术后复发转移相关性研究

目的探讨手术前后中性粒细胞⁃淋巴细胞比值(neutrophil⁃to⁃lymphocyte ratio,NLR)、血小板⁃淋巴细胞比值(platelet⁃to⁃lymphocyte ratio,PLR)、淋巴细胞⁃单核细胞比值(lymphocye⁃to⁃monocyte ratio,LMR)、全身免疫炎症指数(systemic immune⁃inflammation index,SII)、系统性炎症反应指数(systemic inflammation response in⁃dex,SIRI)等外周血炎症指标与口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)患者术后复发转移的相关性,为临床评估OSCC患者的预后提供参考。方法本研究通过医院伦理委员会批准,并获得患者知情同意。对行OSCC根治术的160例原发性OSCC患者,收集其术前最后一次和术后1个月血常规,根据是否术前淋巴结转移、分化程度、临床T分期以及是否术后复发转移分组,分析OSCC患者NLR、PLR、LMR、SII、SIRI等外周血炎症指标与以上临床病理指标、术后复发转移的关系。结果160例OSCC患者,术前淋巴结转移和无转移组的术前SII差异有统计学意义(P<0.05);术前NLR、SII、SIRI在不同分化程度组间差异有统计学意义(P<0.05);不同临床T分期组的术前SIRI指标差异有统计学意义(P<0.05)。术前NLR、PLR、SII、SIRI在术后复发转移组和无复发转移组间的差异有统计学意义(P<0.05),术后外周血炎症指标与术后复发转移无关。单因素Cox分析显示:术前外周血炎症指标中,术前NLR、PLR、SII、SIRI是影响OSCC患者复发转移的影响因素;多因素Cox分析结果显示:术前外周血炎症指标中,只有术前NLR是影响患者复发转移的独立危险因素。结论外周血炎症指标中,术前NLR是OSCC患者术后复发转移的独立危险因素,有一定的预测价值。

APRI评分与妊娠期肝内胆汁淤积症的相关性研究

目的探究天冬氨酸转氨酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)与妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的相关性。方法选取安徽医科大学附属巢湖医院产科于2021年9月至2023年3月收治的70例ICP孕妇作为病例组,选择同期70名健康孕妇作为对照组。采用回顾性研究方法,收集并分析两组孕妇分娩前1周的一般资料及实验室资料,并用t检验进行两组间的比较。运用Pearson相关系数法分析APRI与总胆汁酸(total bile acid,TBA)相关性;Logistic回归分析APRI与ICP的关系,采用受试者操作特征(receiver operating characteristic,ROC)曲线评估APRI在ICP中的应用价值。结果ICP组的APRI(1.1±1.2)高于对照组(0.2±0.1),差异有统计学意义(P<0.05)。重度ICP组的APRI(1.9±2.2)与轻度ICP组(0.9±0.7)比较,差异无统计学意义(P>0.05)。在ICP组中,APRI与TBA呈正相关(r=0.657,P<0.05)。Logistic回归分析结果表明,APRI不是ICP发生的独立影响因素(P>0.05)。APRI的曲线下面积(area under the curve,AUC)为0.870(P<0.05)。结论APRI与ICP的发生及其发展有一定的相关性,而对ICP的病情评估未显示出确定价值。

FIB-4、总胆红素及GPRI水平与肝癌切除术后肝功能衰竭并发症的相关性

目的 探究纤维化指数(FIB-4)、总胆红素及γ-谷氨酰转肽酶与血小板比值指数(GPRI)水平与肝癌切除术后肝功能衰竭并发症的相关性。方法 回顾性选取2018年3月至2023年3月在长治医学院附属和平医院接受肝癌切除术治疗的肝癌患者,记录患者术后是否并发肝功能衰竭,将发生肝功能衰竭的患者纳入研究组(n=32),并按照1∶2的比例随机抽取64例术后未发生肝功能衰竭的肝癌患者纳入对照组。比较两组患者的一般资料(年龄、性别、体重指数、肿瘤大小、病灶数目、乙肝表面抗原、淋巴结转移情况、术前Child分级、腹水)情况、实验室指标[总胆红素、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、γ-谷氨酰转肽酶(GGT)]水平,计算并对比两组FIB-4、GPRI水平,分析影响患者术后并发肝功能衰竭的因素。结果 两组在平均年龄、年龄段、性别、体重指数、肿瘤大小、病灶数目、乙肝表面抗原、有无淋巴结转移、腹水方面比较差异均无统计学意义(P>0.05),研究组患者术前Child B级占46.88%,高于对照组(17.19%),差异有统计学意义(P<0.05)。研究组FIB-4、总胆红素及GPRI水平分别为2.73±0.35、(18.55±1.04)μmol/L、4.45±0.51,均高于对照组[1.76±0.28、(14.22±1.56)μmol/L、2.11±0.34],差异均有统计学意义(P<0.05)。研究组和对照组患者的LDH水平比较,差异无统计学意义(P>0.05),研究组患者的ALT、AST、GGT水平分别为(39.55±2.45)、(58.98±2.33)、(122.48±12.21) U/L,均高于对照组[(33.23±2.13)、(36.15±2.38)、(76.89±15.49) U/L],差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,FIB-4、总胆红素、GPRI水平均是肝癌患者术后并发肝功能衰竭的危险因素(P<0.05)。经受试者工作特征(ROC)曲线分析,可知FIB-4、总胆红素、GPRI均对患者术后肝功能衰竭存在较高的预测价值,其曲线下面积(AUC)值分别为0.809、0.846、0.839(P<0.05)。结论 FIB-4、总胆红素、GPRI水平均是肝癌患者术后并发肝功能衰竭的危险因素,且FIB-4、总胆红素、GPRI对预测肝癌切除术后并发肝功能衰竭具有一定应用价值。

肝硬化伴上消化道出血患者外周血APRI的表达水平及临床意义

目的 探讨肝硬化并发上消化道出血患者外周血天门冬氨酸氨基转移酶(AST)和外周血血小板(PLT)比率指数(APRI)的表达水平及临床意义。方法 选取该院在2018年12月至2021年11月收治的肝硬化患者89例作为研究对象,按照是否并发上消化道出血分为出血组(44例)和非出血组(45例)。检测并比较两组患者外周血凝血酶原时间(PT)、纤维蛋白原(FIB)、清蛋白-胆红素(ALBI)及APRI水平,绘制受试者工作特征(ROC)曲线分析APRI及FIB对肝硬化患者并发上消化道出血的预测价值。比较出血组不同临床资料患者的外周血APRI表达水平。结果 出血组外周血APRI表达水平高于非出血组,而FIB水平低于非出血组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,APRI预测肝硬化患者并发上消化道出血的曲线下面积(AUC)为0.714,灵敏度和特异度分别为71.1%和75.0%。出血组肝功能不同Child-Pugh分级患者APRI表达水平表现为A级患者<B级患者<C级患者,差异均有统计学意义(P<0.05);出血组的APRI表达水平表现为重度患者>中度患者>轻度患者,差异均有统计学意义(P<0.05);出血组6个月内死亡患者的APRI表达水平高于存活患者(P<0.05)。结论 肝硬化并发上消化道出血患者的外周血APRI表达水平明显升高,具有一定的预测价值,且外周血APRI表达水平与病情严重程度及预后有关,是潜在的疾病标志物。

Improvement of hepatic fibrosis after tenofovir disoproxil fumarate switching to tenofovir alafenamide for three years

BACKGROUND Both tenofovir alafenamide(TAF)and tenofovir disoproxil fumarate(TDF)are the first-line treatments for chronic hepatitis B(CHB).We have showed switching from TDF to TAF for 96 weeks resulted in further alanine aminotransferase(ALT)improvement,but data remain lacking on the long-term benefits of TDF switching to TAF on hepatic fibrosis.AIM To assess the benefits of TDF switching to TAF for 3 years on ALT,aspartate aminotransferase(AST),and hepatic fibrosis improvement in patients with CHB.METHODS A single center retrospective study on 53 patients with CHB who were initially treated with TDF,then switched to TAF to determine dynamic patterns of ALT,AST,AST to platelet ratio index(APRI),fibrosis-4(FIB-4)scores,and shear wave elastography(SWE)reading improvement at switching week 144,and the associated factors.RESULTS The mean age was 55(28-80);45.3%,males;15.1%,clinical cirrhosis;mean baseline ALT,24.8;AST,25.7 U/L;APRI,0.37;and FIB-4,1.66.After 144 weeks TDF switching to TAF,mean ALT and AST were reduced to 19.7 and 21,respectively.From baseline to switching week 144,the rates of ALT and AST<35(male)/25(female)and<30(male)/19(female)were persistently increased;hepatic fibrosis was also improved by APRI<0.5,from 79.2%to 96.2%;FIB-4<1.45,from 52.8%to 58.5%,respectively;mean APRI was reduced to 0.27;FIB-4,to 1.38;and mean SWE reading,from 7.05 to 6.30 kPa after a mean of 109 weeks switching.The renal function was stable and the frequency of patients with glomerular filtration rate>60 mL/min was increased from 86.5%at baseline to 88.2%at switching week 144.CONCLUSION Our data confirmed that switching from TDF to TAF for 3 years results in not only persistent ALT/AST improvement,but also hepatic fibrosis improvement by APRI,FIB-4 scores,as well as SWE reading,the important clinical benefits of long-term hepatitis B virus antiviral treatment with TAF.

中性粒细胞/淋巴细胞比值与白塞病疾病活动性的相关性

目的探讨中性粒细胞/淋巴细胞比值(NLR)与白塞病(BD)疾病活动性的相关性。方法103例BD患者依据电子病历疾病活动性指数(EMRAI)评分分为低活动性组(0~4分,61例)和高活动性组(5~11分,42例)。检测患者白细胞计数(WBC)、中性粒细胞计数(NEU)、淋巴细胞计数(LY)、血小板计数(PLT)、红细胞计数(RBC)、血红蛋白(Hb)、红细胞沉降率(ESR)、C反应蛋白(CRP)、IgG、IgA、IgM及补体C3、C4,计算NLR和血小板/淋巴细胞比值(PLR);分析NLR、PLR与全体患者ESR、CRP、EMRAI的相关性;采用Logistic回归分析BD疾病活动性的影响因素;绘制受试者工作特征(ROC)曲线,评估NLR对BD疾病活动性的判断效能。结果高活动性组患者WBC、NEU、PLT、ESR、CRP、NLR、PLR及补体C3、C4均高于低活动性组(P<0.05),余指标差异均无统计学意义(P>0.05)。NLR与全体患者ESR、CRP、EMRAI呈正相关,PLR与全体患者ESR、CRP、EMRAI呈正相关(P<0.05)。Logistic回归分析显示,高NLR是BD疾病活动性的危险因素(OR=1.511,95%CI:1.080~2.113,P<0.05)。ROC曲线分析结果显示,NLR评估BD疾病活动性的曲线下面积(AUC)为0.706(95%CI:0.603~0.809)。结论NLR对BD患者疾病活动性有一定的判断效能,可作为BD疾病活动性评估的生物学指标。