AIM To investigate the value of the gamma-glutamyltraspeptidase(GGT)-to-platelet(PLT) ratio(GPR) in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B(CHB). METHODS We included 390 untreated CHB pa...AIM To investigate the value of the gamma-glutamyltraspeptidase(GGT)-to-platelet(PLT) ratio(GPR) in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B(CHB). METHODS We included 390 untreated CHB patients in this study. The GPR, aspartate aminotransferase(AST)-to-PLT ratio index(APRI), and fibrosis-4(FIB-4) of all patients were analysed to determine if these parameter were correlated with age, gender, medical history, liver function [total bilirubin(TBil), alanine aminotransferase(ALT), and AST], GGT, PLT count, or hepatic fibrosis stage. The GPR, APRI, and FIB-4, as well as the combination of the GPR and APRI or the GPR and FIB-4 were assessed in different cirrhosis stages using receiver operating characteristic(ROC) curve analysis to evaluate their value in diagnosing hepatic fibrosis in CHB patients. RESULTS The GPR, APRI, and FIB-4 were not correlated withCHB patients' age, gender, or disease duration(P > 0.05), but all of these parameters were positively correlated with serum ALT, AST, GGT, and PLT count(P < 0.01). Additionally, the GPR, APRI, and FIB-4 were positively correlated with hepatic fibrosis(P < 0.01); the areas under the ROC curve for the GPR in F1, F2, F3, and F4 stages were 0.723, 0.741, 0.826, and 0.833, respectively, which were significantly higher than the respective values for the FIB-4 and APRI(F1: 0.581, 0.612; F2: 0.706, 0.711; F3: 0.73, 0.751; and F4: 0.799, 0.778). The respective diagnostic cut-off points for each stage were 0.402, 0.448, 0.548, and 0.833, respectively. The diagnostic sensitivity and specificity were, respectively, 88.8% and 87.5% in F1, 72.7% and 89.7% in F2, 81.3% and 98.6% in F3, and 80% and 97.4% in F4 when the GPR and APRI were connected in parallel; 86.6% and 90.2%, 78.4% and 96%, 78.6% and 97.4%, and 73.2% and 97.9%, respectively, when the GPR and APRI were connected in series; 80.2% and 89%, 65% and 89%, 70.3% and 98.5%, and 78.8% and 96.8%, respectively, when the GPR and FIB-4 were connected in parallel; and 83.6% and 87.9%, 76.8% and 96.6%, 展开更多
目的探讨肝功能检查和门冬氨酸氨基转移酶／血小板指数（aspartate aminotr-ans—ferase-to-platelet ratio index，APRI）与肝脏纤维化程度的关系，阐述其在BA肝纤维化评估中的临床价值。方法收集2006年2月至2011年8月间在我院治疗的...目的探讨肝功能检查和门冬氨酸氨基转移酶／血小板指数（aspartate aminotr-ans—ferase-to-platelet ratio index，APRI）与肝脏纤维化程度的关系，阐述其在BA肝纤维化评估中的临床价值。方法收集2006年2月至2011年8月间在我院治疗的胆道闭锁患儿38例和胆汁淤积综合征患儿25例为研究对象。临床观察指标包括肝功能检查，肝脏活检切片，血小板指数；肝硬化程度采用Metavir分类，APRI的诊断陛评估采用ROC曲线，应用SPSS16．O统计学软件进行统计分析。并对本组患儿进行随访，随访时间是3～69个月（平均随访时间：20．7个月）。结果胆道闭锁组患儿ALP、γ-GT、DBIL（564．14±257．75、153．36±97．47、7．55±2．57）较胆汁淤积综合征组患儿存在明显升高（P〈0．05）；胆道闭锁肝硬化组患儿Age、ALT、AST、γ-GT（84．50±24．72、225．07±109．68、331．64±130．93、951．07±667．24）较非肝硬化组明显升高，两组差异具有统计学意义（P〈0．05）；胆汁淤积综合征肝纤维化组患儿Age、ALT、AST（84．76±14．28、159．92±61．76、238．15±62．60）较非肝纤维化组（54．17±11．17、98．92±58．08、151．17±41．44）明显升高，两组差异具有统计学意义（P〈0．05）。患儿绘制APRI的ROC曲线，用于判定肝硬化程度，胆道闭锁组敏感性为79％，特异性为88％；胆汁淤积综合征组敏感性为91％，特异性为79％。胆道闭锁中肝硬化组病死率显著高于非肝硬化组，且自体肝生存情况低于非肝硬化组。结论肝功能检查可以作为胆道闭锁的初步判断指标，绘制APRI的ROC曲线对于评价胆道闭锁及胆汁淤积综合征患儿的肝脏纤维化情况均有较高准确性和可靠性，可用于预测预后和提早做好肝移植准备，因其简单、无创性可以在临床上广泛应用。展开更多
目的 研究Fibroscan与APRI诊断年龄〉40岁且ALT持续正常的慢性乙型肝炎患者肝纤维化程度的价值。方法对138例符合条件的患者行肝脏活检确定病理分级。测定LSM值及APRI值,分析这两种方法诊断2级以上肝纤维化的ROC曲线下面积（F≥2,F0~F1...目的 研究Fibroscan与APRI诊断年龄〉40岁且ALT持续正常的慢性乙型肝炎患者肝纤维化程度的价值。方法对138例符合条件的患者行肝脏活检确定病理分级。测定LSM值及APRI值,分析这两种方法诊断2级以上肝纤维化的ROC曲线下面积（F≥2,F0~F1与F2~F4对比）,从而判断这两种方法的诊断价值,并将两种方法进行并联实验、串联实验,以研究联合两种方法的诊断价值。结果Fibroscan诊断2级以上肝纤维化的AUROC为0.880,其cutoff值为6.95 k Pa,敏感度为88.9%,特异性为76.3%。APRI诊断2级以上肝纤维化的AUROC为0.865,其cutoff值为0.58,敏感度为73.3%,特异性为81.7%。两种方法并联诊断2级以上肝纤维化敏感度为97.78%,特异性为68.82%,阳性预测值为60.27%,阴性预测值为98.46%;串联诊断2级以上肝纤维化敏感度为60.00%,特异性为91.40%,阳性预测值为77.14%,阴性预测值为82.52%。结论应用Fibroscan和APRI这两种无创诊断肝纤维化的方法可以较好的诊断年龄〉40岁且ALT持续正常的慢性乙型肝炎患者肝纤维化程度。展开更多
基金Supported by National Natural Science Foundation of China,No.81460301 and No.81760363Key Project of Natural Science Foundation of Ningxia,No.NZ15134
文摘AIM To investigate the value of the gamma-glutamyltraspeptidase(GGT)-to-platelet(PLT) ratio(GPR) in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B(CHB). METHODS We included 390 untreated CHB patients in this study. The GPR, aspartate aminotransferase(AST)-to-PLT ratio index(APRI), and fibrosis-4(FIB-4) of all patients were analysed to determine if these parameter were correlated with age, gender, medical history, liver function [total bilirubin(TBil), alanine aminotransferase(ALT), and AST], GGT, PLT count, or hepatic fibrosis stage. The GPR, APRI, and FIB-4, as well as the combination of the GPR and APRI or the GPR and FIB-4 were assessed in different cirrhosis stages using receiver operating characteristic(ROC) curve analysis to evaluate their value in diagnosing hepatic fibrosis in CHB patients. RESULTS The GPR, APRI, and FIB-4 were not correlated withCHB patients' age, gender, or disease duration(P > 0.05), but all of these parameters were positively correlated with serum ALT, AST, GGT, and PLT count(P < 0.01). Additionally, the GPR, APRI, and FIB-4 were positively correlated with hepatic fibrosis(P < 0.01); the areas under the ROC curve for the GPR in F1, F2, F3, and F4 stages were 0.723, 0.741, 0.826, and 0.833, respectively, which were significantly higher than the respective values for the FIB-4 and APRI(F1: 0.581, 0.612; F2: 0.706, 0.711; F3: 0.73, 0.751; and F4: 0.799, 0.778). The respective diagnostic cut-off points for each stage were 0.402, 0.448, 0.548, and 0.833, respectively. The diagnostic sensitivity and specificity were, respectively, 88.8% and 87.5% in F1, 72.7% and 89.7% in F2, 81.3% and 98.6% in F3, and 80% and 97.4% in F4 when the GPR and APRI were connected in parallel; 86.6% and 90.2%, 78.4% and 96%, 78.6% and 97.4%, and 73.2% and 97.9%, respectively, when the GPR and APRI were connected in series; 80.2% and 89%, 65% and 89%, 70.3% and 98.5%, and 78.8% and 96.8%, respectively, when the GPR and FIB-4 were connected in parallel; and 83.6% and 87.9%, 76.8% and 96.6%,
文摘目的探讨肝功能检查和门冬氨酸氨基转移酶／血小板指数（aspartate aminotr-ans—ferase-to-platelet ratio index，APRI）与肝脏纤维化程度的关系，阐述其在BA肝纤维化评估中的临床价值。方法收集2006年2月至2011年8月间在我院治疗的胆道闭锁患儿38例和胆汁淤积综合征患儿25例为研究对象。临床观察指标包括肝功能检查，肝脏活检切片，血小板指数；肝硬化程度采用Metavir分类，APRI的诊断陛评估采用ROC曲线，应用SPSS16．O统计学软件进行统计分析。并对本组患儿进行随访，随访时间是3～69个月（平均随访时间：20．7个月）。结果胆道闭锁组患儿ALP、γ-GT、DBIL（564．14±257．75、153．36±97．47、7．55±2．57）较胆汁淤积综合征组患儿存在明显升高（P〈0．05）；胆道闭锁肝硬化组患儿Age、ALT、AST、γ-GT（84．50±24．72、225．07±109．68、331．64±130．93、951．07±667．24）较非肝硬化组明显升高，两组差异具有统计学意义（P〈0．05）；胆汁淤积综合征肝纤维化组患儿Age、ALT、AST（84．76±14．28、159．92±61．76、238．15±62．60）较非肝纤维化组（54．17±11．17、98．92±58．08、151．17±41．44）明显升高，两组差异具有统计学意义（P〈0．05）。患儿绘制APRI的ROC曲线，用于判定肝硬化程度，胆道闭锁组敏感性为79％，特异性为88％；胆汁淤积综合征组敏感性为91％，特异性为79％。胆道闭锁中肝硬化组病死率显著高于非肝硬化组，且自体肝生存情况低于非肝硬化组。结论肝功能检查可以作为胆道闭锁的初步判断指标，绘制APRI的ROC曲线对于评价胆道闭锁及胆汁淤积综合征患儿的肝脏纤维化情况均有较高准确性和可靠性，可用于预测预后和提早做好肝移植准备，因其简单、无创性可以在临床上广泛应用。
文摘目的 研究Fibroscan与APRI诊断年龄〉40岁且ALT持续正常的慢性乙型肝炎患者肝纤维化程度的价值。方法对138例符合条件的患者行肝脏活检确定病理分级。测定LSM值及APRI值,分析这两种方法诊断2级以上肝纤维化的ROC曲线下面积（F≥2,F0~F1与F2~F4对比）,从而判断这两种方法的诊断价值,并将两种方法进行并联实验、串联实验,以研究联合两种方法的诊断价值。结果Fibroscan诊断2级以上肝纤维化的AUROC为0.880,其cutoff值为6.95 k Pa,敏感度为88.9%,特异性为76.3%。APRI诊断2级以上肝纤维化的AUROC为0.865,其cutoff值为0.58,敏感度为73.3%,特异性为81.7%。两种方法并联诊断2级以上肝纤维化敏感度为97.78%,特异性为68.82%,阳性预测值为60.27%,阴性预测值为98.46%;串联诊断2级以上肝纤维化敏感度为60.00%,特异性为91.40%,阳性预测值为77.14%,阴性预测值为82.52%。结论应用Fibroscan和APRI这两种无创诊断肝纤维化的方法可以较好的诊断年龄〉40岁且ALT持续正常的慢性乙型肝炎患者肝纤维化程度。
