红细胞分布宽度-血小板比值评估自身免疫性肝炎患者肝纤维化严重程度的回顾性研究

肝脏 ›› 2023, Vol. 28 ›› Issue (8): 957-960.

红细胞分布宽度-血小板比值评估自身免疫性肝炎患者肝纤维化严重程度的回顾性研究

陈黎霞, 沈丽磊, 郑毅

215101 江苏苏州市中西医结合医院检验科(陈黎霞,沈丽磊) ;苏州大学附属第二医院检验科(郑毅)

收稿日期:2022-10-08 出版日期:2023-08-31 发布日期:2023-09-21
通讯作者: 沈丽磊,Email:153813832@qq.com
基金资助:
苏州中西医结合医院科技项目(YJ2018003)

Retrospective study of red blood cell distribution width-platelet ratio in evaluating the severity of liver fibrosis in patients with autoimmune hepatitis

CHEN Li-xia¹, SHEN Li-lei¹, ZHENG Yi²

1. Department of Laboratory ,Suzhou Integrated Traditional Chinese and Western Medicine Hospital, Jiangsu 215101, China;
2. Department of Laboratory, the Second Affiliated Hospital of Suzhou University, Jiangsu 215101, China

Received:2022-10-08 Online:2023-08-31 Published:2023-09-21
Contact: SHEN Li-lei, Email:153813832@qq.com

摘要/Abstract

摘要： 目的比较自身免疫性肝炎(AIH)、药物性肝损伤(DILI)的临床资料差异,并评估AIH患者肝纤维化严重程度的影响因素及其诊断效能。方法回顾2015年6月—2022年8月期间苏州市中西医结合医院收治的AIH患者45例(AIH组),男4例、女41例;DILI患者86例(DILI组),男23例、女63例;AIH、DILI诊断符合要求。使用Metavir系统对肝纤维化程度进行评分,其中<F2期为非显著肝纤维化,≥F2期为显著肝纤维化,比较两者临床资料信息,采用单变量和多变量分析影响AIH患者晚期肝纤维化的因素。应用ROC曲线以及AUC值评估红细胞分布宽度-血小板(RPR)对AIH肝纤维化严重程度诊断的准确性。结果 AIH患者年龄、皮肤瘙痒、ALP、球蛋白、TBA、PT及RDW分别为54(48, 63)岁、6例(13.3%)、154(119, 278)U/L、36.1(31.2, 44.0)g/L、50.4(17.8, 140.6)μmol/L、11.8(11.2, 13.4)s及15.1(13.6, 16.4)%,均显著高于DILI[50(41, 58)岁、0(0)、121(82, 187)U/L、28.3(24.6, 31.8)g/L、25.6(8.9, 108.4)μmol/L、11.2(10.8,12.3)s及14.1(13.0,15.5)%,P<0.05];而AIH患者男性、PLT水平分别为4例(8.9%)、162(126, 203)×10⁹/L,均显著低于DILI[23例(26.7%)、204(173, 352)×10⁹/L,P<0.05]。单变量分析显示,非显著、显著肝纤维化AIH患者IgA、RDW、FIB-4、GPR及RPR差异有统计学意义;多变量分析发现,IgA、GPR及RPR升高,AIH患者显著肝纤维化风险显著增加,而年龄、性别、IgG、RDW、APRI及FIB-4与AIH患者显著肝纤维化之间无明显关联。RPR对AIH患者显著肝纤维化的截断点、ROC值、敏感度及特异度分别为-2.3、0.82、82.3%(14/17)及78.6%(22/28)。结论 AIH患者的组织学肝纤维化程度与RPR和血清IgA水平显著相关。

关键词: 自身免疫性肝炎, 药物性肝损伤, 红细胞分布宽度-血小板, 肝纤维化

Abstract: Objective To compare the clinical data of patients of autoimmune hepatitis (AIH) and drug-induced liver injury (DILI), and then to evaluate the associated factors of liver fibrosis severity and the diagnostic efficiency of AIH patients.Methods From June 2015 to August 2022, 45 patients with AIH (AIH group) were reviewed, including 4 males and 41 females. 86 patients with DILI (DILI group) were also included (23 males and 63 females). Metavir system was used to score the degree of hepatic fibrosis, in which < F2 stage was defined as non-significant hepatic fibrosis, and ≥F2 stage was significant hepatic fibrosis. The clinical data of the two groups were compared, and univariate and multivariate analysis were used to analyze the associated factors of advanced hepatic fibrosis in AIH patients. ROC curve and AUC value were used to evaluate the accuracy of red blood cell distribution width-Platelet (RPR) in the diagnosis of AIH liver fibrosis severity.Results In AIH patietnts, the age, skin pruritus, ALP, globulin, TBA, PT and RDW of AIH patients were 54 (48, 63) years old, 6 cases (13.3%), 154 (119, 278) U/L, 36.1 (31.2, 44.0) g/L, 50.4 (17.8, 140.6) μmol/L, 11.8 (11.2, 13.4) s and 15.1 (13.6, 16.4)%, which was significantly higher than that of DILI [50 (41, 58) years old, 0 (0), 121 (82, 187) U/L, 28.3 (24.6, 31.8) g/L, 25.6 (8.9, 108.4) μmol, 11.2 (10.8, 12.3) s and 14.1(13.0, 15.5) %, respectively, P<0.05]. In AIH patients, PLT was 4 cases (8.9%) and 162 (126, 203) × 10⁹/L, which were significantly lower than those in DILI [23 cases (26.7%) and 204 (173, 352) × 10⁹/L, P<0.05]. Univariate analysis showed that IgA, RDW, FIB-4, GPR and RPR were significant associated with significant hepatic fibrosis in AIH patients. Multivariate analysis showed that increased IgA, GPR and RPR levels, were significant associated with significant hepatic fibrosis, while age, sex, IgG, RDW, APRI and FIB-4 had no significant correlation with significant hepatic fibrosis in AIH patients. The cutoff point, ROC value, sensitivity and specificity of RPR for AIH patients with significant liver fibrosis were -2.3, 0.82, 82.3% (14/17) and 78.6% (22/28), respectively.Conclusion RPR and serum IgA levels were significantly related to .histological liver fibrosis in patients with AIH.

Key words: Autoimmune hepatitis, Drug-induced liver injury, Red blood cell distribution width-platelet ratio, Liver fibrosis

陈黎霞, 沈丽磊, 郑毅. 红细胞分布宽度-血小板比值评估自身免疫性肝炎患者肝纤维化严重程度的回顾性研究[J]. 肝脏, 2023, 28(8): 957-960.

CHEN Li-xia, SHEN Li-lei, ZHENG Yi. Retrospective study of red blood cell distribution width-platelet ratio in evaluating the severity of liver fibrosis in patients with autoimmune hepatitis[J]. Chinese Hepatolgy, 2023, 28(8): 957-960.

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