GPR参数模型联合Fibroscan对慢性乙型肝炎肝纤维化的诊断效能

肝脏 ›› 2022, Vol. 27 ›› Issue (8): 877-880.

GPR参数模型联合Fibroscan对慢性乙型肝炎肝纤维化的诊断效能

张鑫, 朱桂娟, 叶晓航, 张荣荣, 张睿, 朱礼尧, 姚梦础

223000 江苏淮安市第四人民医院影像科(张鑫,朱桂娟,叶晓航,张荣荣),肝病科(张睿,朱礼尧);淮安市第一人民医院(姚梦础)

收稿日期:2021-10-06 出版日期:2022-08-31 发布日期:2022-09-30
通讯作者: 姚梦础,Email:973306782@qq.com
基金资助:
2020年江苏省高层次卫生人才“六个一工程”拔尖人才项目(LGY2020059);中国公共卫生联盟(第一批)课题项目(GWLM202016)

Clinical value of GPR parameter model combined with Fibroscan for evaluating the stage of liver fibrosis in patientes with chronic hepatitis B

ZHANG Xin¹, ZHU Gui-juan¹, YE Xiao-hang¹, ZHANG Rong-rong¹, ZHANG Rui², ZHU Li-yao², YAO Meng-chu³

1. Department of Imaging, 2. Department of Hepatology, Huaian Fourth People's Hospital, Jiangsu 223000, China;
3. Huaian First People's Hospital, Jiangsu 223000, China

Received:2021-10-06 Online:2022-08-31 Published:2022-09-30
Contact: YAO Meng-chu,Email:973306782@qq.com

摘要/Abstract

摘要： 目的评估GPR参数模型联合Fibroscan对慢性乙型肝炎(CHB)肝纤维化中的的诊断效能。方法选择2015年1月至2020年12月淮安市第四人民医院收治的患者161例。穿刺前1周内检测Fibroscan (LSM值)以及γ-谷氨酰转肽酶(GGT)、血小板(PLT)计数,并计算 GGT/PLT比值(GPR)指数。分析GPR、LSM值与肝纤维化程度的相关性;分析GPR参数模型联合Fibroscan对CHB肝纤维化诊断的准确性。结果 CHB患者F0-F4期LSM值分别为(5.06±1.48)、(5.65±1.48)、(6.29±1.14)、(8.65±2.75)、(14.03±4.24)kPa,差异有统计学意义(F=64.327,P<0.01);与病理肝纤维化分期呈正相关( r=0.730,P<0.01)。F0-F4期GPR值分别为0.32±0.22、0.46±0.40、0.57±0.50、0.80±0.72、1.20±1.06,差异有统计学意义(F=4.921,P<0.01),与病理肝纤维化分期呈正相关 ( r=0.384,P<0.05)。当以F≥2为分割点进行分组,单独LSM、GPR值和LSM+GPR联合的ROC曲线下面积分别为0.851、0.711、0.862; F≥3时,单独LSM、GPR值和LSM+GPR联合的ROC曲线下面积分别为0.899、0.722、0.911;F=4时,单独LSM、GPR值和LSM+GPR联合的ROC曲线下面积分别为0.921、0.711、0.926。结论 LSM+GPR联合诊断肝纤维化的能力均高于单独的LSM 、GPR值,GPR参数模型联合Fibroscan可提高慢性乙型肝炎肝纤维化诊断效能。

关键词: 乙型肝炎, 肝纤维化, 瞬时弹性记录仪, 参数模型

Abstract: Objective To investigate the clinical value of GPR parameter model combined with FibroScan for evaluating the stage of liver fibrosis in patients with chronic hepatitis B (CHB).Methods A total of 161 patients with CHB who underwent liver biopsy in our hospital were selected. The clinical date liver stiffness measurement (LSM), gamma-glutamyl transpeptidase (GGT), platelet (PLT) and GPR at 1 week before puncture were collected. To analyze the correlation between GPR, LSM and the degree of liver fibrosis; to analyze the accuracy of GPR parameter model combined with FibroScan in the diagnosis of liver fibrosis in CHB patients.Results The liver LSM values of CHB patients with degree of fibrosis from F0 to F4 were 5.06±1.48, 5.65±1.48, 6.29±1.14, 8.65±2.75 and 14.03±4.24KPa, respectively; and the differences were statistically significant (F=64.327, P<0.001). The LSM value was positively correlated with the stage of pathology (r=0.730, P<0.001). The GPR values of CHB patients with degree of fibrosis from F0 to F4 were 0.32±0.22, 0.46±0.40, 0.57±0.50, 0.80±0.72 and 1.20±1.06, respectively; and the differences were statistically significant (F=4.921, P<0.001). The GPR value was also positively correlated with pathological staging (r=0.384, P<0.05). The area under the curve (AUC) values of LSM, GPR, and LSM combined with GPR for the diagnosis of F≥2 were 0.851, 0.711, and 0.862, respectively. The AUC values of LSM, GPR, and LSM combined with GPR for the diagnosis of F≥3 were 0.899, 0.722 and 0.911, respectively. The AUC values of LSM, GPR, and LSM combined with GPR for the diagnosis of F=4 were 0.921, 0.711 and 0.926, respectively.Conclusion The predictive value of LSM combined with GPR in the diagnosis for liver fibrosis is better than that of LSM or GPR alone. GPR parameter model combined with Fibroscan can be used as a more accurate non-invasive diagnosis model for liver fibrosis, which is worthy of clinical application.

Key words: Hepatitis B, Liver fibrosis, Transient elastograph, Parameter model

张鑫, 朱桂娟, 叶晓航, 张荣荣, 张睿, 朱礼尧, 姚梦础. GPR参数模型联合Fibroscan对慢性乙型肝炎肝纤维化的诊断效能[J]. 肝脏, 2022, 27(8): 877-880.

ZHANG Xin, ZHU Gui-juan, YE Xiao-hang, ZHANG Rong-rong, ZHANG Rui, ZHU Li-yao, YAO Meng-chu. Clinical value of GPR parameter model combined with Fibroscan for evaluating the stage of liver fibrosis in patientes with chronic hepatitis B[J]. Chinese Hepatolgy, 2022, 27(8): 877-880.

参考文献

[1] Marcellin P,Gane E,Buti M ,et al. Regression of cirrhosis during treatment with tenofovirdisoproxilfumarate forchronic hepatitis B: a 5-year open-label follow-up study. Lancet, 2013, 381:468-475.
[2] Lemoine M, Shimakawa Y, Nayagam S, et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut ,2016,65:1369-1376.
[3] 中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎防治指南(2019 年版).肝脏,2019, 24:1335-1356.
[4] Scott DR,Levy MT. Liver transient elastography(Fibrosean ):aplace in the m anagementalgorithms of chronic viral hepafitis. Antivir Ther,2010,15:1-11 .
[5] Kawamoto M, Mizuguchi T, Katsuramaki T, et al. Assessment of liver fibrosis by a noninvasive method of transient elastography and biochemical markers. World Journal of Gastroenterology, 2006, 12:4325-4330.
[6] Alisi A, Pinzani M, Nobili V. Diagnostic power of fibroscan in predicting liver fibrosis in nonalcoholic fatty liver disease. Hepatology, 2010, 50:2048-2049.
[7] Takemoto R, Nakamuta M, Aoyagi Y,et al. Validity of FibroScan values for predicting hepatic fibrosis stage in patients with chronic HCV infection. J Dig Dis, 2009, 10:145-148.
[8] Wang JH, Changchien CS, Hung CH, et al. FibroScan and ultrasonography in the prediction of hepatic fibrosis in patients with chronic viral hepatitis. J Gastroenterology, 2009, 44:439-446.
[9] Karlas T,Dirtrich A,Peter V,et al.Evaluation of transient elastography, acoustic radiation force impulse imaging (ARFI),and enhanced liver function (ELF) Score for detection of fibrosis in morbidly obese patients. Plos one,2015,10:139-145.
[10] 张荣荣, 周瑾, 赵鹏, 等. 剪切波弹性成像与血清肝纤维化指标无创评估慢性乙型肝炎患者肝纤维化效能比较. 肝脏,2020,26: 255-258.
[11] Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. World Health Organization, 2015.
[12] 李强,黄玉仙,陈良. γ-谷氨酰转肽酶/血小板计数模型对慢性乙型肝炎患者明显肝纤维化和肝硬化的诊断价值. 中华传染病杂志 ,2016,34:360-361.
[13] Li Q,Li W,Huang Y,et al. The gamma-glutamyl transpeptidase-to-platelet ratio predicts liver fibrosis and cirrhosis in HBeAg-positive chronic HBV infection patients with high HBV DNA and normal or mildly elevated alanine transaminase levels in China. J Viral Hepat,2016,23:912-919.
[14] Boyd A, Bottero J, Lacombe K. The gamma-glutamyltranspeptidase-to - p latelet ratio as a predictor of Iiver fibrosisin patients co -infected with HBV and HIV. Gut,2016,65 :718-720.
[15] Merli M,Caastagna A,Salpietro S,et al.Diagnostic accuracy of APRI,FIB-4 and forns for the detection of liver cirrhosis in HIV/HCV-coinfeeted patients. New Microbiol,2016,39 :110-113.