非侵入性诊断模型在慢性乙型肝炎患者肝纤维化中的应用

Application of Noninvasive Diagnostic Model in Liver Fibrosis of Patients with Chronic Hepatitis B

摘要: 目的：比较血清学标志物INR-血小板比率(INR-to-platelet ratio, INPR)、球蛋白–血小板比率 (The globulin-PLT ratio, GP)、γ-谷氨酰转肽酶与血小板比率(the gamma-glutamyl traspeptidase to platelet ratio, GPR)对慢性乙肝患者肝纤维化分期的诊断价值，筛选出一种高效的肝纤维化诊断工具。方法：回顾性收集200例慢性乙肝肝炎患者的临床和瞬时弹性成像资料。慢性乙型肝炎患者分为以下三组：显著肝纤维化组、晚期肝纤维化组和肝硬化组。通过受试者工作特征曲线(Receiver Op-erating Characteristic, ROC)分析INPR、GP、GPR诊断显著肝纤维化、晚期肝纤维化和肝硬化的诊断效能，用Delong检验比较各ROC曲线的差异。结果：在评估显著纤维化方面，GPR诊断效能显著高于其他四个血清学标志物，天冬氨酸氨基转移酶/血小板比率指数(APRI)、FIB-4、GP、GPR和INPR的AUC分别为0.839、0.771、0.784、0.893和0.784。在评估晚期纤维化和肝硬化时，其诊断效能没有明显差别。结论：GPR、GP、INPR对于慢性乙肝患者肝纤维化分期的诊断均具有较高的效能，其中GPR对于显著肝纤维化的诊断效能最优。

Abstract: Objective: In order to screen an efficient diagnostic tool for liver fibrosis, we compare the diagnostic value of the serological markers INR-to-platelet ratio (INPR), the globulin-PLT ratio (GP), the gam-ma-glutamyl transpeptidase to platelet ratio (GPR) in the staging of liver fibrosis in patients with chronic hepatitis B. Methods: The clinical and transient elastography data of 200 patients with chronic hepatitis B were retrospectively analyzed. CHB patients were divided into the following three groups: significant liver fibrosis group, advanced liver fibrosis group, cirrhosis group. The di-agnostic efficacy of INPR, GP and GPR in the diagnosis of significant liver fibrosis, advanced liver fi-brosis and cirrhosis was analyzed by Receiver Operating Characteristic curve. Delong test was used to compare the differences of ROC curves. Results: The diagnostic efficacy of GPR was significantly higher than that of the other four serological markers in evaluating significant fibrosis. The AUC of aspartate aminotransferase/platelet ratio index (APRI), FIB-4, GP, GPR and INPR were 0.839, 0.771, 0.784, 0.893 and 0.784. There was no significant difference in diagnostic efficacy between advanced fibrosis and cirrhosis. Conclusions: GPR, GP and INPR have high efficacy in the diagnosis of liver fi-brosis stage in patients with chronic hepatitis B, among which GPR has the best efficacy in the diag-nosis of significant liver fibrosis.