摘要
目的探讨肝脏瞬时弹性检测技术(FibroTouch)、血清肝纤维化指标、APRI评分三种无创性肝纤维化评价方法对肝功能轻微异常的慢性HBV感染者肝纤维化的评估价值。方法选取2014年1月至2017年1月福建医科大学孟超肝胆医院107例丙氨酸转氨酶(ALT)≤80 U/L并行肝穿刺活组织检查的慢性HBV感染者,根据肝穿刺活组织检查病理分为轻微肝纤维化组(S1,n=26)、明显肝纤维化组(S2~3,n=34)和早期肝硬化组(S4,n=47),比较三组患者的肝弹性硬度值(LSM)、层黏连蛋白(LN)、Ⅲ型前胶原N端肽(PⅢP N-P)、Ⅳ型胶原(CⅣ)、透明质酸(HA)及APRI等指标,并采用Spearman等级相关分析各指标与肝脏纤维化分期的相关性。采用Logistic回归分析建立多指标联合预测肝纤维化程度模型,绘制受试者工作曲线(ROC曲线)比较分析三种纤维化评价方法及预测模型对不同肝纤维化分期的预测价值。结果明显肝纤维化组的LSM高于轻微肝纤维化组(Z=-2.611,P<0.01)。早期肝硬化组的PⅢP N-P、CⅣ、LN、HA水平均高于轻微肝纤维化组(Z=-4.026、-4.205、-2.938和-3.156,P值均<0.01)。早期肝硬化组的LSM和APRI高于轻微肝纤维化组(Z=-5.789和-4.308,P值均<0.01)和明显肝纤维化组(Z=-3.460和-3.498,P值均<0.01)。早期肝硬化组的血小板低于轻微肝纤维化组和明显肝纤维化组(Z=-4.533和-3.206,P<0.01)。相关性分析显示,LSM、CⅣ、PⅢP N-P及APRI与肝纤维化分期呈正相关(r=0.606、0.418、0.396和0.470,P值均<0.01)。各单指标预测肝纤维化S≥2和S=4的效能比较,差异均无统计学意义(P值均>0.05)。利用Logistic回归分析建立预测肝纤维化S≥2的模型1:Logit(P)=-3.810+0.385×LSM+0.052×CⅣ,曲线下面积为0.839,特异度为96.0%,诊断效能分别优于PⅢP N-P、CⅣ和APRI(Z=2.579、2.145和2.219,P值均<0.05),但与LSM相比,差异无统计学意义(Z=1.001,P>0.05)。利用Logistic回归分析构建预测肝纤维化S=4的模型2:Logit(P)=-4.291+0
Objective To compare FibroTouch,serum hepatic fibrosis index and aspartate aminotransferase-to-platelet ratio index(APRI)in diagnosis of liver fibrosis and early cirrhosis for patients with chronic HBV infection with mild abnormal liver function.Methods One hundred and seven chronic HBV infected patients with alanine transaminase(ALT)≤80 U/L who underwent liver biopsy in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2014 to January 2017 were enrolled in the study.According to the liver biopsy pathology,the patients were divided into mild liver fibrosis group(S1,n=26),significant fibrosis group(S2-3,n=34)and early cirrhosis group(S4,n=47).The differentiations of liver stiffness measurement(LSM),Laminin(LN),Collagen TypeⅢN-peptide(PⅢP N-P),Collagen Type IV(CⅣ),Hyaluronic acid(HA)and APRI were compared among the three groups,and their correlations with fibrosis were analyzed with Spearman rank correlation analysis.Logistic regression analysis was performed to establish a multi-index model for predicting the degree of liver fibrosis,and the receiver operating characteristic(ROC)curves were drawn to compare and analyze the predictive value for different stages of liver fibrosis.Results The LSM in the significant fibrosis group was higher than that in the mild liver fibrosis group(Z=-2.611,P<0.01).The levels of PⅢP N-P,CIV,LN and HA in early cirrhosis group were higher than those in mild liver fibrosis group(Z=-4.026,-4.205,-2.938 and-3.156,all P<0.01).LSM and APRI in early liver cirrhosis group was higher than that in mild liver fibrosis group(Z=-5.789 and-4.308,both P<0.01)and significant liver fibrosis group(Z=-3.460 and-3.498,both P<0.01).PLT in early liver cirrhosis group was lower than that in mild liver fibrosis group and significant liver fibrosis group(Z=-4.533 and-3.206,both P<0.01).The correlation analysis showed that the values of LSM,CIV,PⅢP N-P and APRI were positively correlated with the stage of liver fibrosis(r=0.606,0.418,0.396 and 0.470,respectively;all P<0.01)
作者
周丽娜
林春
潘晨
孙芳
林勇
周锐
杨文彦
Zhou Lina;Lin Chun;Pan Chen;Sun Fang;Lin Yong;Zhou Rui;Yang Wenyan(Department of Hepatology,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,Fujian Province,China)
出处
《中华临床感染病杂志》
CSCD
2019年第4期268-274,共7页
Chinese Journal of Clinical Infectious Diseases
基金
福州市科技计划项目(2018-S-103-4).
