| 摘要: |
| 目的 探讨γ-谷氨酰转肽酶与血小板比率（GPR）对慢性乙型肝炎肝纤维化的诊断效能，并与瞬时弹性成像肝脏硬度测定（LSM）值、天冬氨酸转氨酶与血小板比率指数（APRI）及基于4因子的纤维化指数（FIB-4）的诊断效能进行比较。方法 回顾性纳入2015年5月至9月于我院接受手术治疗或肝病理活组织检查的慢性乙型肝炎患者。所有患者均在术前空腹下行FibroTouch瞬时弹性成像检查及常规血清学检查，记录LSM值，并计算GPR、APRI及FIB-4。通过受试者工作特征（ROC）曲线评估各指标的诊断效能并对ROC曲线下面积进行比较。结果 最终纳入260例慢性乙型肝炎患者，男213例、女47例，平均年龄为（53.49±9.78）岁，体质量指数为（23.36±3.06）kg/m2。GPR、LSM值、APRI及FIB-4均与S≥2期及S4期肝纤维化中度相关（P均<0.05）。GPR、LSM值、APRI及FIB-4诊断S≥2期肝纤维化的ROC曲线下面积分别为0.81、0.82、0.75和0.72，诊断S4期肝纤维化的ROC曲线下面积分别0.82、0.86、0.79和0.75。GPR和LSM值诊断S≥2期及S4期肝纤维化的ROC曲线下面积均较FIB-4高（P均<0.05），LSM值诊断S4期肝纤维化的ROC曲线下面积较APRI高（P<0.05）。APRI与FIB-4诊断S≥2期和S4期肝纤维化的ROC曲线下面积差异均无统计学意义（P均>0.05）。结论 GPR、LSM值、APRI及FIB-4均对慢性乙型肝炎S≥2期和S4期肝纤维化有一定的诊断准确性；LSM值及GPR对S≥2期和S4期肝纤维化的诊断准确性优于FIB-4，LSM值对S4期肝纤维化的诊断准确性优于APRI。因此，LSM值及GPR可作为无创性评估慢性乙型肝炎患者肝纤维化的优选指标。 |
| 关键词: 肝纤维化 γ-谷氨酰转肽酶与血小板比率 瞬时弹性成像 天冬氨酸转氨酶与血小板比率指数 基于4因子的纤维化指数 |
| DOI：10.16781/j.0258-879x.2019.09.0984 |
| 投稿时间：2019-05-05修订日期：2019-07-01 |
| 基金项目:上海申康医院发展中心临床科技创新项目（SHDC22015004）. |
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| Efficiency of γ-glutamyl transpeptidase to platelet ratio for diagnosis of liver fibrosis in chronic hepatitis B patients |
| SHEN Cui-qin,LI Wan-bin,LEI Jie-wen,TAN Bi-bo,GUO Jia* |
(Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital, Naval Medical University(Second Military Medical University), Shanghai 200438, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the diagnostic efficiency of γ-glutamyl transpeptidase to platelet ratio (GPR) for detecting liver fibrosis in chronic hepatitis B patients, and to compare its efficiency with those of liver stiffness measurement (LSM) value, asperate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4). Methods We retrospectively included patients with chronic hepatitis B who had undergone surgery or liver biopsy in our hospital from May 2015 to Sep. 2015. All patients had undergone transient elastography to record LSM value and serological examination to calculate GPR, APRI and FIB-4 before surgery or liver biopsy. The diagnostic efficiency of each index was evaluated by receiver operating characteristic (ROC) curve and the area under ROC curve was compared. Results Totally 260 patients were eventually enrolled in the present study, including 213 males and 47 females, with the average age being (53.49±9.78) years and the average BMI being (23.36±3.06) kg/m2. GPR, LSM value, APRI and FIB-4 were moderately correlated with S ≥ 2 and S4 liver fibrosis (all P<0.05). The areas under ROC curves of GPR, LSM value, APRI and FIB-4 for S ≥ 2 liver fibrosis were 0.81, 0.82, 0.75 and 0.72, respectively. For predicting S4 liver fibrosis, the areas under ROC curves of GPR, LSM value, APRI and FIB-4 were 0.82, 0.86, 0.79 and 0.75, respectively. The areas under ROC curves of GPR and LSM value were significantly higher than those of FIB-4 for detecting S ≥ 2 and S4 liver fibrosis (all P<0.05). For predicting S4, the area under ROC curve of LSM value was significantly better than APRI (P<0.05). There were no statistical differences in the areas under ROC curves between APRI and FIB-4 for diagnosis of S ≥ 2 and S4 liver fibrosis (P>0.05). Conclusion It has been indicated that GPR, LSM value, APRI and FIB-4 have diagnostic accuracy for S ≥ 2 and S4 liver fibrosis. The diagnostic accuracy of LSM value and GPR for S ≥ 2 and S4 liver fibrosis is better than that of FIB-4, and that of LSM value for S4 liver fibrosis is better than that of APRI. Therefore, GPR and LSM value may serve as the optimal indexes for noninvasively evaluating liver fibrosis in chronic hepatitis B patients. |
| Key words: liver fibrosis γ-glutamyl transpeptidase to platelet ratio transient elastography asperate aminotransferase to platelet ratio index fibrosis-4 index |
