血液及超声指标对慢性乙型肝炎早期肝硬化的诊断价值

目的探讨慢性乙型肝炎（CHB）患者血液及超声指标联合诊断早期肝硬化（S4）的价值。方法选择2002年4月至2011年3月入住沈阳市第六人民医院并进行肝活组织检查（肝活检）的CHB患者631例。收集患者的血液和超声检查结果，利用Logistic回归分析等方法筛选出与早期肝硬化独立相关的指标并建立诊断模型。采用受试者工作特征曲线下面积（AUROC）评价本模型与FIB4指数、天冬氨酸转氨酶与血小板比值（APRI）指数和s指数诊断早期肝硬化的价值。结果回归分析提示，年龄、血小板（PLT）、白蛋白／球蛋白（A／G）以及脾脏面积（SPS）是与早期肝硬化相关的独立因素（Wald=10056，46．236，3．75l和10．669，P〈0．01）。由这四项指标构成的模型预测早期肝硬化的AUROC达0．908，诊断价值优于FIB-4指数、APRI指数和s指数（Z=8．322，4．334和4．087，P〈0．05）。取0．063为诊断的临界值，本模型预测s4的敏感度、特异度、阳性预测值和阴性预测值分别为90．1％，77．8％，50．0％和97．1％。以〈0．060和≥0．110作为除外和诊断的界值，可使69．7％（440／631）的患者免于肝活检。结论由年龄、PLT、A／G、SPS四项指标建立的模型可有效预测早期肝硬化，并可使部分患者免于肝活检。

Ultrasound and blood indicators in diagnosis of early cirrhosis for patients with chronic hepatitis B

Objective To investigate the application of ultrasound and blood indicators in diagnosis of early liver cirrhosis （ S4 ） for patients with chronic hepatitis B （ CHB ）. Methods Data of blood and ultrasound examinations of 631 patients with CHB who received liver biopsy in the Sixth People＇ s Hospital of Shenyang during April 2002 and March 2011 were collected. Logistic regression analysis was performed to determine the factors independently correlated with early liver cirrhosis, and the diagnostic model was established using these indicators. The diagnostic value of the established model was assessed by using area under receiver operating characteristic curve （AUROC） and compared with FIB-4 index, aspartate aminotransferase （AST）/platelet （PLT） ratio index （APRI） and S index. Results Logistic regression analysis indicated that age, PLT, albumin globulin ratio （A/G） and splenic square area （SPS） in ultrasound findings were independently correlated to early liver cirrhosis （ Wald = 10056, 46. 236, 3. 751 and 10. 669, P 〈0. 01 ）. AUROC of the model based on the above factors in diagnosing early liver cirrhosis was 0. 908, which was higher than those of FIB-1 index, APRI index and S index （Z = 8. 322, 4. 334 and 4. 087, P 〈 0. 05）. Taking 0. 063 as cut-off value, the sensitivity, specificity, positive predict value and negative predict value of the established model in diagnosis of early liver cirrhosis were 90. 1% , 77.8% , 50. 0% and 97. 1% , respectively. Taking 〈 0. 060 and ≥ 0. 110 as the cut-off values to exclude, and diagnose early liver cirrhosis, 69. 7% （440/631） patients could avoid liver biopsy. Conclusion The model based on age, PLT, A/G and SPS can effectively predict early liver cirrhosis, and can reduce liver biopsy.