慢性乙型肝炎患者血小板指数与肝组织病理的关系

目的研究慢性乙型肝炎(CHB)患者AST/血小板(PLT)比值(APRI)及ALT/PLT比值(BPRI)与肝组织病理改变的关系。方法收集2004年2月-2014年2月于柳州市人民医院行肝活组织检查的CHB患者167例,检测患者的血常规及肝功能,将APRI、BPRI与肝组织病理进行分析。计量资料组间比较采用Mann-Whitney U检验,分析评价采用受试者工作特征(ROC)曲线法。结果在肝组织病理炎症分级G0、G1、G2、G3、G4各组中,APRI进行比较,G1与G2、G3差异均具有统计学意义(P值均0.05);G0~1组与G2~4组的APRI比较差异有统计学意义(P0.05)。各组BPRI进行比较,G0与G4、G1与G2差异均有统计学意义(P值均0.05)。G0~1与G2~4进行比较,BPRI差异有统计学意义(P0.05)。在S0、S1、S2、S3、S4各组中,APRI、BPRI两两比较,S2与S3差异均有统计学意义(P值均0.05)。APRI、BPRI预测肝组织炎症G2~4的ROC曲线下面积分别为0.748、0.736(95%可信区间分别为0.669~0.827、0.653~0.819,P值均0.000 1),APRI、BPRI预测肝组织炎症G2~4级的最佳截断值分别为0.601、0.630,灵敏度分别63.6%、82.7%,特异度分别为74.5%、59.6%,约登指数分别为39.0%、42.4%。结论 APRI、BPRI可作为预测CHB患者肝组织炎症活动度的指标,但APRI、BPRI可能无法预测CHB患者肝纤维化分期。

Correlation between platelet indices and liver pathological staging:an analysis of 167 patients with chronic hepatitis B

Objective Toinvestigatethevaluesofaspartateaminotransferasetoplateletratioindex(APRI)andalanineaminotransferaseto platelet ratio index (BPRI)for the prediction of pathological changes in liver tissue in patients with chronic hepatitis B (CHB).Methods Atotalof167CHBpatientswhovisitedthePeople′sHospitalofLiuzhoufromFebruary2004toFebruary2014werecollected.Liverbiopsy, routine blood test,and liver function test were performed,and then the correlation between APRI/BPRI and liver pathology was analyzed. The Mann-Whitney U test was applied for comparison of continuous data between groups,and the receiver operating characteristic (ROC) curvewasusedtoevaluatethepredictivevaluesofAPRIandBPRIforliverpathologicalstaging.Results APRIwascomparedbetweenG0, G1,G2,G3,and G4 groups with different liver inflammation grades,and the G1 group had a significantly different APRI value than the G2 and G3 groups (both P<0.05);the G0-1 group had a significantly different APRI value than the G2-4 group (P<0.05).BPRI was al-so compared between these groups,and it differed significantly between the G0 group and G4 group and between the G1 group and G2 group (both P<0.05);the G0-1 group had a significantly different BPRI value than the G2-4 group (P<0.05).APRI and BPRI were com-pared between each two of S0,S1,S2,S3,and S4 groups,and they showed significant differences between the S2 and S3 groups (P<0.05).The areas under the ROC curve of APRI and BPRI for predicting liver inflammation G2 -4 were 0.748 and 0.736,respectively (95%CI:0.669-0.827 and 0.653-0.819,respectively;both P<0.000 1);the optimal cut-off values for APRI and BPRI to predict liver inflammation G2-4 were 0.601 and 0.630,respectively,with sensitivity,specificity,and Youden index of 63.6%/82.7%,74.5%/59.6%,and39.0%/42.4%,respectively.Conclusion APRIandBPRIcanbeusedtopredictliverinflammatoryactivityinCHBpatients.