摘要
目的分别在乙型肝炎e抗原(hepatitis B e antigen,HBeAg)阳性和与阴性慢性乙型肝炎患者框架内,评价天冬氨酸转氨酶/血小板比值指数(aspartate aminotransferase-to-platelet ratio index,APRI)及其构件指标AST和血小板(platelet,PLT)对肝脏纤维化程度与肝脏炎性反应和坏死的预测性能。方法纳入在上海市公共卫生临床中心接受肝活组织检查(简称活检)的初治慢性乙型肝炎患者577例,其中HBeAg阳性和阴性患者分别为323和254例。应用Hitachi 7600全自动生化分析仪检测血清AST水平,应用Sysmex-XT 4000i全自动血细胞分析仪检测外周血PLT计数。肝脏病理学诊断采用Scheuer评分系统。APRI分值、AST和PLT相对值的正态性转换采用Blom公式。结果二因素方差分析显示,对于HBeAg阳性和阴性患者,不同病理学分级患者的APRI和AST相对值的正态分值之间的差异均有统计学意义(P值均<0.01),PLT计数相对值之间的差异均无统计学意义(P值均>0.05);不同病理学分期APRI和AST相对值的正态分值之间的差异均无统计学意义(P值均>0.05),PLT计数相对值之间的差异均有统计学意义(P值均<0.05)。ROC曲线分析显示,对于HBeAg阳性患者,APRI预测病理学分级≥G2的ROC曲线的AUC(AUROC)为0.805(95%CI为0.757~0.847)显著大于PLT计数的0.623(95%CI为0.568~0.676),差异有统计学意义(P<0.001);预测病理学分级≥G3的AUROC为0.830(95%CI为0.785~0.870),显著大于AST的0.793(95%CI为0.745~0.836)和PLT计数的0.742(95%CI为0.690~0.788),差异均有统计学意义(P=0.006和0.003);预测病理学分期≥S2、≥S3和≥S4的AUROC分别为0.751(95%CI为0.700~0.797)、0.768(95%CI为0.718~0.813)和0.787(95%CI为0.738~0.830),显著大于AST的0.707(95%CI为0.654~0.756)、0.703(95%CI为0.650~0.752)和0.707(95%CI为0.654~0.756),差异均有统计学意义(P=0.001、<0.001和<0.001)。对于HBeAg阴性患者,APRI预测病理学分级≥G2和≥G3的AUROC分别为0.849(95%CI为0.799~0.890)和0.889(95%CI为0.843~0.924),显著大于PLT计数的0.701(95%CI为0.641~0.757)和0.718(95%CI为0.659~0.773),差异均有统计学意义(P值均<0.001);预测病理学分期≥S2的AUROC分别为0.756(95%CI为0.698~0.807),显著大于PLT计数的0.666(95%CI为0.604~0.724,P=0.004);预测病理学分期≥S3和≥S4的AUROC分别为0.810(95%CI为0.756~0.856)和0.821(95%CI为0.769~0.866),显著大于AST的0.764(95%CI为0.707~0.815)和0.760(95%CI为0.702~0.811),差异均有统计学意义(P=0.004,0.001)。结论APRI预测肝脏病理状态的优势主要体现在预测肝脏炎性反应和坏死,其预测肝脏纤维化程度的有效性应当是其预测肝脏炎性反应和坏死的关联效应。
Objective To investigate the performance of aspartate aminotransferase to platelet ratio index(APRI),aspartate aminotransferase(AST),and platelet(PLT)in predicting the degree of hepatic fibrosis and necroinflammtory activity in hepatitis B e antigen(HBeAg)positive and negative patients with chronic hepatitis B.Methods A total of 577 naive patients with chronic hepatitis B,who underwent liver biopsy at Shanghai Public Health Clinical Center of Hehai University,were enrolled.HBeAg was positive in 323 patients and negative in 254 patients.Serum AST was detected using a Hitachi 7600 automatic biochemical analyzer.Peripheral blood PLT was detected using a Sysmex-XT 4000 i automatic blood cell analyzer.Liver histopathological diagnosis was performed with reference to the Scheuer scoring system.Normal conversion of APRI and relative values of AST and PLT was based on the Blom formula.Results According to two-factor analysis of variance,regardless of HBeAg positive or negative patients,there were significant differences in the normal scores of APRI and AST relative value(all P<0.005),but there was no significant difference in PLT relative value(all P>0.05)between different pathologic grades.There was no significant difference in the normal scores of APRI and AST relative value(P>0.05),but there was a significant difference in PLT relative value(all P<0.05)between different pathologic stages.In HBeAg positive patients,the area under ROC curve(AUROC)of APRI in predicting pathological grade≥G2(0.805,95%CI:0.757-0.847)was significantly larger than that of PLT(0.623,95%CI:0.568-0.676,P<0.001);AUROC of APRI in predicting pathological grade≥G3(0.830,95%CI:0.785-0.870)was significantly larger than that of AST(0.793,95%CI:0.745-0.836)and PLT(0.742,95%CI:0.690-0.788,P=0.006,0.003);AUROC of APRI in predicting pathological stage≥S2(0.751,95%CI:0.700-0.797),≥S3(0.768,95%CI:0.718-0.813)and≥S4(0.787,95%CI:0.738-0.830)was significantly larger than that of AST(0.707,95%CI:0.654-0.756;0.703,95%CI:0.650-0.752;0.707,95%CI:0.654-0.756,P=0.001,P<0.001 and P<0.001).In HBeAg negative patients,AUROC of APRI in predicting pathological grade≥G2(0.849,95%CI:0.799-0.890)and≥G3(0.889,95%CI:0.843-0.924)was significantly larger than that of PLT(0.701,95%CI:0.641-0.757;0.718,95%CI:0.659-0.773,all P<0.001);AUROC of APRI in predicting pathological stage≥S2(0.756,95%CI:0.698-0.807)was significantly larger than that of PLT(0.666,95%CI:0.604-0.724,P=0.004);AUROC of APRI in predicting pathological stage≥S3(0.810,95%CI:0.756-0.856)and≥S4(0.821,95%CI:0.769-0.866)was significantly larger than that of AST(0.764,95%CI:0.707-0.815;0.760,95%CI:0.702-0.811,P=0.004,0.001).Conclusion APRI can be mainly used for predicting hepatic necroinflammtory activity.Its effectiveness in predicting hepatic fibrotic levels may be due to the correlation effect of predicting hepatic necroinflammtory activity.
作者
张正华
金红弟
张秀华
陆伟
周新兰
王雁冰
张占卿
ZHANG Zhenghua;JIN Hongdi;ZHANG Xiuhua;LU Wei;ZHOUXinlan;WANG Yanbing;ZHANG Zhanqing(Department of Infectious Diseases,Guhua Hospital of Fengxian istrict,Shanghai 201499,China)
出处
《上海医学》
CAS
北大核心
2020年第1期29-37,共9页
Shanghai Medical Journal
基金
上海市市级医院新兴前沿技术联合攻关项目(SHDC12016237)
国家“十二五”传染病科技重大专项(2013ZX10002005).
关键词
天冬氨酸转氨酶/血小板比值
乙型肝炎
慢性
病理学
肝硬化
无创诊断
Aspartate aminotransferase to platelet ratio index
Hepatitis B,chronic
Pathology
Liver fibrosis
Noninvasive diagnosis
