| 摘要: |
| 目的研究比较非病毒性因素造成肝损患者的肝组织学病理与临床非创伤性指标之间的关系。方法收集上海交通大学附属仁济医院行肝穿刺活检的非病毒性肝病患者222例,分析患者肝组织炎症活动度、纤维化程度与血清学、影像学检查等非创伤性指标之间的相关性。结果年龄、肝功能指标、血小板(PLT)、天冬氨酸转氨酶/血小板(AST/PLT)比值、天冬氨酸转氨酶/丙氨酸转氨酶(AST/ALT)比值、白蛋白/球蛋白(A/G)比值均与肝组织病理分级分期有显著相关性。以1倍ALT水平正常值上限(ULN)为界,病理炎症分级差异有统计学意义(P=0.009)；以2ULN为界时,纤维化分期差异有统计学意义(P=0.030)。B超检查与肝组织病理炎症分级、纤维化分期呈正相关(r=0.417,P=0.000；r=0.530,P=0.000)。AST/PLT比值和凝血酶原时间(PT)在肝纤维化组与无肝纤维化组之间差异有统计学意义(P=0.015,P=0.000),AST/ALT、AST/PLT、A/G比值和PT值在肝硬化组与无肝硬化组之间差异均有统计学意义(P=0.042,0.012,0.000,0.003)。无创性诊断模型APRI预测肝纤维化和肝硬化的ROC曲线下面积(AUC)在3个预测模型中最大,APRI诊断肝纤维化和S-Index诊断肝硬化的灵敏度较高,但特异度不高；S-Index诊断肝纤维化和Forns’score诊断肝硬化的特异性较高,但灵敏度欠佳。结论临床非创伤性指标对评价非病毒性肝病肝组织病理的炎症活动程度和纤维化程度有一定的预测意义。无创性诊断模型对肝纤维化、早期肝硬化有一定的诊断预测价值。 |
| 关键词: 非病毒性肝病 肝组织病理 非创伤性检查 无创性诊断模型 |
| DOI：10.3724/SP.J.1008.2011.0830 |
| 投稿时间：2011-05-17修订日期：2011-07-20 |
| 基金项目: |
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| Relationship between hepatic histopathological progression and findings of clinical noninvasive examination in patients with non-viral liver diseases |
| CHEN Li-ping1,FAN Zhu-ping2*,PENG Yan-shen1,QIU De-kai1 |
| (1. Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai 200001, China;2. Health Care Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai 200001, China) |
| Abstract: |
| ObjectiveTo elucidate the relationship between hepatic histopathologic progression and findings of clinical noninvasive examination in patients with non-viral liver diseases. MethodsA total of 222 patients with non-viral liver diseases, who received liver biopsy in our hospital, were included in the present study. The association of different histopathological progression (grade of hepatic inflammation and stage of fibrosis) with the noninvasive examination parameters (serum biochemical indicators and imaging findings) was investigated. ResultsWe found that age,serum biochemical indicators, platelet (PLT), and ratios of aspartate aminotransferase to platelet (AST/PLT), aspartate aminotransferase to alanine aminotransferase (AST/ALT) and albumin to globulin (A/G) were significantly associated with the histopathological grades and stages of hepatic tissues. The grades of inflammation were markedly different between 2 groups with ALT levels higher or lower than 1 upper limits of normal (ULN) (P=0.009); the stages of hepatic fibrosis were significantly different between 2 groups with ALT levels higher or lower than 2 ULN (P=0.030). The result of B-type ultrasonic examination was positively related to the grade of hepatic inflammation and stage of fibrosis (r=0.417,P=0.000；r=0.530,P=0.000). AST/PLT and prothrombin time (PT) level were significantly different between patients with hepatic fibrosis and those without (P=0.015, P=0.000); AST/ALT, AST/PLT, A/G and PT levels were also significantly different between cirrhotic patients and non cirrhotic ones (P=0.042,0.012,0.000,and 0.003, respectively). The area under ROC curve of noninvasive analysis model APRI was the largest one among the 3 models. APRI model had the highest sensitivity in diagnosing liver fibrosis, but with a poor specificity; S-Index had a higher specificity but a poor sensitivity. ConclusionClinical noninvasive parameters are valuable for evaluating the activity of hepatic inflammation and stage of fibrosis in patients with non-viral liver diseases. Noninvasive analysis model is useful for diagnosing liver fibrosis and early cirrhosis. |
| Key words: non-viral liver diseases liver histopathologic progression noninvasive examination noninvasive analysis model |
