FibroScan联合GGT/PLT比值预测慢性乙型肝炎患者肝纤维化的初步探讨

目的初步探讨FibroScan联合GGT/PLT比值(GPR)预测慢性乙型肝炎(CHB)患者肝纤维化分期的诊断价值。方法选取广州市第八人民医院2012年1月-2016年12月肝活组织检查诊断为CHB患者278例,分析GPR、FibroScan以及二者联合诊断预测纤维化分期(F0～F4)的价值。非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用MannWhitney U检验。相关性分析采用Spearman相关系数。受试者工作特征曲线下面积(AUC)评估肝纤维化分期。结果以肝活组织检查作为金标准,F1～F4期患者分别有50、104、92和32例。随着肝纤维化分期加重,FibroScan检测肝硬度值(LSM)逐渐升高(P值均<0. 05); GPR在肝纤维化F1、F2、F3期逐渐升高(P值均<0. 05)。GPR、FibroScan均与肝纤维化呈正相关(r值分别为0. 419、0. 481,P值均<0. 001); GPR与FibroScan呈正相关(r=0. 436,P <0. 001)。FibroScan与GPR联合预测进展期肝纤维化(≥F3)的诊断效能优于单一FibroScan(AUC:0. 793 vs 0. 739,Z=3. 044,P=0. 002)或GPR(AUC:0. 793 vs 0. 740,Z=2. 389,P=0. 037);二者联合预测明显肝纤维化(≥F2)的诊断效能优于单一GPR(AUC:0. 782 vs 0. 714,Z=2. 130,P=0. 033)。结论 FibroScan与GPR联合诊断对于预测CHB进展期肝纤维化(≥F3)具有优势,初步认为可提高诊断效能。

Value of FibroScan combined with gamma-glutamyl transpeptidase-to-platelet ratio in predicting liver fibrosis in patients with chronic hepatitis B:A preliminary study

Objective To investigate the value of FibroScan combined with gamma-glutamyl transpeptidase-to-platelet ratio(GPR)in predicting liver fibrosis stage in patients with chronic hepatitis B(CHB).Methods A total of 278 patients who were diagnosed with CHB by liver biopsy in Guangzhou Eighth People’s Hospital from January 2012 to December 2016 were enrolled.The value of GPR and FibroScan used alone or in combination in predicting liver fibrosis stage(F0-F4)was analyzed.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and the Mann-Whitney U test was used for further comparison between two groups.The Spearman’s correlation coefficient was used for correlation analysis.The area under the receiver operating characteristic curve(AUC)was used to evaluate liver fibrosis stage.Results With liver biopsy as the gold standard,of all patients,50 had stage F1 fibrosis,104 had stage F2 fibrosis,92 had stage F3 fibrosis,and 32 had stage F4 fibrosis.Liver stiffness measurement by FibroScan gradually increased with the increase in liver fibrosis stage(P<0.05),and GPR also increased gradually in patients with stage F1,F2,and F3 liver fibrosis(P<0.05).GPR and FibroScan were positively correlated with liver fibrosis(r=0.419 and 0.481,both P<0.001),and GPR was positively correlated with FibroScan(r=0.436,P<0.001).According to AUC,FibroScan combined with GPR had a better diagnostic efficiency than FibroScan(0.793 vs 0.739,Z=3.044,P=0.002)or GPR(0.793 vs 0.740,Z=2.389,P=0.037)alone in predicting progressive liver fibrosis(≥F3);FibroScan combined with GPR had a better diagnostic efficiency than GPR alone(0.782 vs 0.714,Z=2.130,P=0.033)in predicting marked liver fibrosis(≥F2).Conclusion FibroScan combined with GPR has a certain advantage in predicting progressive liver fibrosis(≥F3)in CHB patients and can improve diagnostic efficiency.