摘要
目的探讨TBA、IgM、FIB-4评分对原发性胆汁性胆管炎(primary biliary cholangitis,PBC)相关肝纤维化的诊断价值。方法选取2019年10月至2022年9月在我院并行肝穿刺活检的PBC患者76例。采用Scheuer评分系统评估肝纤维化程度:早期肝纤维化(S_(0)~S_(1))、显著肝纤维化(≥S_(2))。利用公式计算血清学无创模型APRI、FIB-4、ALBI、INPR。采用Logistic回归分析筛选影响患者肝纤维化的危险因素。绘制ROC曲线评估各无创血清学模型对PBC患者肝纤维化的诊断效能。结果显著纤维化组患者的年龄、性别与早期纤维化组比较,差异均无统计学意义(P>0.05)。显著纤维化组血ALB水平、PLT水平低于早期纤维化组,血ALP水平、TBA水平、IgM水平、APRI评分、FIB-4评分、ALBI评分、INPR评分高于早期纤维化组(P<0.05)。多因素分析显示,血TBA高水平、血IgM高水平、FIB-4高评分是PBC患者肝纤维化进展的独立危险因素(P<0.05)。TBA、IgM、FIB-4诊断显著肝纤维化的AUC分别为0.8629、0.8642、0.8351;三者联合诊断的模型TIF诊断显著肝纤维化的敏感性为94%,特异性为86%,AUC为0.9180。结论血TBA高水平、血IgM高水平、FIB-4高评分是PBC患者肝纤维化进展的独立危险因素。TBA、IgM、FIB-4及三项指标联合诊断可在一定程度上替代肝活检评估肝纤维化进展程度。
Objective To investigate the diagnostic value of TBA,IgM and FIB-4 scores in primary biliary cholangitis(PBC)patients with liver fibrosis.Methods A total of 76 patients with PBC who were hospitalized in our hospital and underwent liver biopsy from Oct.2019 to Sep.2022 were selected.The histological stage was divided into S 0-S 4,and the degree of liver fibrosis was divided into early liver fibrosis(S_(0)-S_(1))and significant liver fibrosis(≥S_(2)).Serological noninvasive models APRI,FIB-4,ALBI and INPR were calculated using formulas.The risk factors of liver fibrosis were screened by Logistic regression analysis.ROC curve was developed to evaluate the diagnostic efficacy of noninvasive serological models in PBC patients with fibrosis.Results There were no significant differences in age and gender between the significant fibrosis group and the early fibrosis group(P>0.05).The serum ALB level and PLT level in the significant fibrosis group were lower than those in the early liver fibrosis group,and the serum ALP level,TBA level,IgM level,APRI score,FIB-4 score,ALBI score and INPR score were higher than those in the early liver fibrosis group(P<0.05).Multivariate analysis indicated high blood TBA level,high blood IgM level and high FIB-4 score were independent risk factors for liver fibrosis progression in patients with PBC(P<0.05).The AUC of TBA,IgM and FIB-4 for the diagnosis of significant liver fibrosis were 0.8629,0.8642 and 0.8351,respectively.The sensitivity and specificity of TIF for the diagnosis of significant liver fibrosis were 94%,86%,and AUC was 0.9180.Conclusion High blood TBA level,high blood IgM level and high FIB-4 score are independent risk factors for the progression of PBC patients with liver fibrosis.The combined diagnosis of TBA,IgM,FIB-4 and 3 indexes can replace liver biopsy to evaluate the progression of liver fibrosis.
作者
李兆明
章颖
邹美银
LI Zhaoming;ZHANG Ying;ZOU Meiyin(Department of Hepatology,Nantong Third People′s Hospital,Affiliated Nantong Hospital 3 of Nantong University,Nantong 226006,China;Department of Infectious Disease,Nantong Third People′s Hospital,Affiliated Nantong Hospital 3 of Nantong University,Nantong 226006,China)
出处
《胃肠病学和肝病学杂志》
CAS
2023年第11期1254-1257,共4页
Chinese Journal of Gastroenterology and Hepatology
基金
南通市市级科技计划(MSZ19083)。
