不同血清诊断模型对肝纤维化的诊断价值

The Value of Serum Diagnostic Models in the Diagnosis of Hepatic Fibrosis

摘要: 目的：分析肝段切除患者术前的血清学指标并建立血清诊断模型，评价血清诊断模型对肝纤维化的应用价值。方法：回顾性收集我院2017年6月至2019年12月肝段切除患者术前的血清学指标，计算天冬氨酸转氨酶/血小板比值指数(aspartate aminotransferase to platelet ratio index, APRI)、γ谷氨酰转肽酶/血小板比值指数(γ-glutamyltranspeptidase to platelet ratio, GPR)、基于四因子的纤维化指数(fibrosis index based on the four factors, FIB-4)以及AST/ALT比值(AST/ALT ratio, AAR)四种肝纤维化诊断模型，使用ROC曲线评价每种诊断模型对≥S1、≥S2、≥S3以及≥S4四种肝纤维化分组的诊断能力。结果：APRI、GPR、FIB-4三种模型对于四种肝纤维化分组均有统计学意义，P值范围为(0.000~0.049)，AAR对每种分组均没有意义。FIB-4模型诊断不同分期肝纤维化性能最佳，其中对于≥S1期肝纤维化诊断价值最大，AUC达0.960，以约登指数最大值计算临界值为0.850。结论：APRI、GPR、FIB-4三种血清诊断模型可以提示不同分期肝纤维化，FIB-4模型对≥S1期肝纤维化价值最佳。

Abstract: Objective: To analyze the preoperative serological indexes of patients with segmental hepatectomy and establish serum diagnostic models, and to evaluate the application value of serum diagnostic model in liver fibrosis. Methods: Serological indexes of patients undergoing segmental hepatectomy in our hospital from June 2017 to December 2019 were collected retrospectively. Four hepatic fibrosis diagnostic models of aspartate aminotransferase/platelet ratio index (APRI), gamma glutamyl transpeptidase/platelet ratio index (GPR), fibrosis index based on four factors (FIB-4) and AST/ALT ratio (AAR) were calculated. ROC curve was used to evaluate the diagnostic ability of each diagnostic model for ≥S1, ≥S2, ≥S3 and ≥S4 liver fibrosis groups. Results: The three models of APRI, GPR and FIB-4 had statistical significance for the four groups of liver fibrosis with the range of P value (0.000~0.049); AAR was not significant for each group. FIB-4 had the best diagnostic performance in different stages of liver fibrosis, in which the diagnostic value of ≥S1 stage was the highest with the AUC 0.960. The critical value calculated by the maximum value of Jordan index was 0.850. Conclusion: Three serum diagnostic models of APRI, GPR and FIB-4 can indicate different stages of liver fibrosis, and FIB-4 model is the best for ≥S1 stage of liver fibrosis.