肝硬化判别评分诊断慢性乙型病毒性肝炎肝纤维化的临床价值

目的:探讨肝硬化判别评分诊断慢性乙型病毒性肝炎肝纤维化的临床价值。方法:172例慢性乙型病毒性肝炎患者均接受肝组织病理检查,并同时检测肝功能、血常规和凝血功能,用ROC曲线评价肝硬化判别评分诊断无或轻度肝纤维化(S0/S1)、显著肝纤维化(S2/S3/S4)、严重肝纤维化(S3/S4)和肝硬化(S4)的能力。结果:S4的肝硬化判别评分明显高于S0、S1、S2和S3(P<0.01);肝纤维化分期和肝硬化判别评分的相关系数rs=0.375(P<0.01);肝硬化判别评分诊断显著肝纤维化的ROC曲线下的面积0.726,阳性预测值95.3%,肝硬化的AUC 0.814,阴性预测值96.5%,严重肝纤维化的AUC仅有0.626,敏感度38.8%。结论:肝硬化判别评分和肝纤维化分期有一定的相关性,肝硬化判别评分可以用于评估慢性乙型病毒性肝炎患者有无显著肝纤维化或肝硬化,但对S2和S3的区分能力有限。

Clinical value of Bonacini's cirrhosis discriminant score to the diagnosis of liver fibrosis in chronic virus hepatitis B

Objective To testify the clinical value of cirrhosis discriminant score to the diagnosis of liver fibrosis in chronic virus hepatitis B.Methods One hundred and seventy-two patients with chronic virus hepatitis B underwent liver biopsy and their liver function,blood routine and blood clotting function were detected simultaneously.Three different endpoints were studied according to liver fibrosis stage,namely significant fibrosis(S2/S3/S4),extensive fibrosis(S3/S4) and cirrhosis(S4).The AUC reflected its diagnostic values.Results The cirrhosis discriminant score of S4 was higher than those of S0,S1,S2 and S3(P<0.01).The correlation coefficient between liver fibrosis stage and cirrhosis discriminant score was 0.375(P<0.01).The AUC for significant fibrosis,extensive fibrosis and cirrhosis were 0.726,0.626 and 0.814,respectively.The positive predictive value for significant fibrosis was 95.3%.The negative predictive value for cirrhosis was 96.5%.The sensitivity for extensive fibrosis was 38.8%.Conclusion There is correlation between liver fibrosis stage and cirrhosis discriminant score.Cirrhosis discriminant score can evaluate significant fibrosis and cirrhosis in patients with chronic virus hepatitis B,however,it can not discriminate fibrosis S2 and S3.