谷氨酰转肽酶与血小板比值在评估肝细胞癌肝纤维化分期中的价值

目的 探讨谷氨酰转肽酶与血小板比值（gamma-glutamy transpeptidase to platelet ratio，GPR）在评估肝细胞癌（hepatocellular carcinoma，HCC）患者肝纤维化分期中的价值。方法 收集2015年8月至2016年8月在广西医科大学附属肿瘤医院肝胆外科行肝切除术的HCC患者的临床资料，计算GPR、天门冬氨酸氨基转移酶与血小板比值指数（amino- transferase to platelet ratio index，APRI）、FIB4指数（index based on the 4 factors，FIB4），用ROC曲线下面积比较GPR、APRI、FIB4诊断肝纤维化不同分期（S0期、S1期、S2期、S3期、S4期）的效能。结果 GPR、APRI、FIB4、谷丙转氨酶（alanine transaminase，ALT）与肝纤维化分期呈正相关（P＜0.05），而血小板计数（blood platelet count，PLT）与肝纤维化分期呈负相关（r=-0.360，P＜0.001）；肝纤维化不同分期（S0期、S1期、S2期、S3期、S4期）中，GPR、APRI、FIB4、PLT值差异均有统计学意义（P＜0.05）；肝纤维化＞S0期，GPR曲线下面积分别与APRI、FIB4、PLT曲线下面积比较，差异均无统计学意义（P＞0.05）；肝纤维化＞S1期和＞S3期中，GPR曲线下面积分别相应与APRI、PLT曲线下面积比较，差异均无统计学意义（P＞0.05），但高于FIB4曲线下面积，差异有统计学意义（P＜0.05）；肝纤维化＞S2期，GPR曲线下面积分别相应与APRI、PLT曲线下面积比较，差异均有统计学意义（P＜0.05）。结论 GPR诊断肝纤维化分期具有较高的准确性，可作为评估HCC患者术前肝纤维化分期的无创性指标。

Ratio of gamma-glutamyl transpeptidase to platelets for staging hepatic fibrosis in patients with hepatocellular carcinoma

Objective To assess the usefulness of the ratio of gamma-glutamyl transpeptidase to platelets （GPR）for staging hepatic fibrosis in patients with hepatocellular carcinoma（HCC）. Methods Medical records were collected and analyzed for 194 patients who underwent curative liver resection from August 2015 to August 2016 at our hospital. GPR，the ratio index of aminotransferase to platelets （APRI） and the four-factor index （FIB4） were compared for their ability to stage hepatic fibrosis based on the area under the receiver operating characteristic curve. Results Liver fibrosis stage correlated positively with GPR，APRI，FIB4 and ALT，but negatively with PLT （all P＜0.05）. GPR，APRI，FRONS，FIB4，and PLT differed significantly in different stages of liver fibrosis （P＜0.05）. Among patients with liver fibrosis stage > S0，the indices GPR，APRI，FIB4 and PLT showed similar areas under the curve （P＞0.05）. In contrast，among patients with liver fibrosis stages > S1 and S3 ，GPR showed an area under the curve similar to that of APRI and PLT （P＞0.05） but different from that of FIB4（P＜0.05）. The area under the GPR curve was significantly greater than the areas under the APRI and PLT curves（P＜0.05）. Conclusions GPR is simple to calculate from data obtained during routine clinical it can be more accurate for staging liver fibrosis than other indices. It may therefore be useful as a noninvasive index for preoperative staging of hepatic fibrosis in HCC patients.