γ-谷氨酰转肽酶/血小板比值对血清转氨酶正常的慢性HBV感染者肝纤维化的预测价值分析*

目的 探讨γ-谷氨酰转肽酶/血小板比值(GPR)预测转氨酶正常的慢性HBV感染者肝纤维化分期的价值。方法 2010年~2016年我院诊治的血清转氨酶正常的慢性HBV感染者202例,经肝活检诊断肝纤维化,计算GPR、AST与PLT比值指数（APRI）和基于4因素的肝纤维化指数（FIB-4）预测明显肝纤维化（≥F2）、进展期肝纤维化（≥F3）和早期肝硬化（F4）的效能。应用ROC曲线下面积（AUC）判断诊断效能。结果 经肝组织病理学检查,本组发现F1、F2、F3和F4 分别为82例、60例、39例和21例;F4组GPR、APRI和FIB-4分别为0.4（0.2,1.0）、（0.6±0.2）和1.6（0.9,1.8）,而F3组分别为0.2（0.2,0.4）、（0.6±0.2）和0.9（0.9,1.2）,F2组则分别为0.2（0.1,0.3）、0.4±0.2和0.9（0.7,1.3）,差异显著（P<0.05）;GPR预测明显肝纤维化（≥F2）、进展期肝纤维化（≥F3）和早期肝硬化（F4）的AUC分别是0.739、0.790和0.824,显著高于APRI（分别为0.547、0.731和0.736,P<0.05）;GPR预测肝纤维化≥F3的AUC为0.790,显著高于FIB-4（0.748,P<0.05）,而FIB-4预测肝纤维化≥F2的AUC为0.777,显著高于GPR（0.739,P<0.05）,FIB-4和GPR预测肝硬化（F4）的效能之间无显著性差异（分别为0.824和0.792,P>0.05）。结论 GPR可以预测转氨酶正常的慢性HBV感染者肝纤维化分期,其效能优于APRI,而与FIB-4相比,各有优缺点。GPR可以作为对转氨酶正常的慢性HBV感染者肝纤维化一个无创生化预测指数。

Prediction of liver fibrosis by gamma-glutamyl-transpeptidase-to-platelet ratio in patients with chronic hepatitis B viral infection with normal serum transaminase levels

Objective To investigate the predictive of liver fibrosis by gamma-glutamyl-transpeptidase-to-platelet ratio （GPR） in patients with chronic hepatitis B viral infection with normal serum transaminase levels. Methods 202 patients with chronic HBV infection with normal serum transaminase levels were recruited in our hospital between 2010 and 2016,and all of them underwent liver biopsy. The GPR,AST/PLT ratio index （APRI） and fibrosis index based on the factor（FIB-4） were determined. The area under ROC（AUC） was used for diagnostic efficacy in predicting liver fibrosis. Results F1,F2,F3 and F4 were found in 82,60,39 and 21 cases by the liver biopsies as the gold standard;the GPR,APRI and FIB-4 in patients with F4 were 0.4（0.2,1.0）,（0.6±; 0.2） and 1.6（0.9,1.8）,respectively,while they were 0.2（0.2,0.4）,（0.6±; 0.2） and 0.9（0.9,1.2） in patients with F3,and 0.2（0.1,0.3）,0.4±; 0.2 and 0.9（0.7,1.3） in patients with F2,respectively,differences significant （P<; 0.05）;the AUC of GPR for significant fibrosis（≥F2）,for advanced fibrosis（≥F3） and liver cirrhosis（F4） were 0.739,0.790 and 0.824,respectively,significant higher than（0.547,0.731 and 0.736） by APRI （P<; 0.05）;the AUC of GPR for liver fibrosis≥F3 was 0.790,significant higher than FIB-4（0.748,P<; 0.05）,while the AUC of FIB-4 for liver fibrosis≥F2 was 0.777,significant higher than GPR （0.739,P<; 0.05）;there was no significant difference as respect to the efficacy to predict liver cirrhosis（F4） between FIB-4 and GPR （AUC=0.824 and 0.792,P>; 0.05）. Conclusion GPR might be used to predict the liver fibrosis stages in patients with chronic HBV infection with normal serum aminotransferase levels,which is better than APRI and might be used as a noninvasive biochemical prediction index in this settings.