性别和年龄对慢性乙型肝炎肝组织病理学状态的预测作用

目的探讨性别和年龄预测慢性乙型肝炎肝组织炎症活动度和纤维化程度的价值。方法慢性乙型肝炎491例，其中病理学诊断为G0、G1、G2、G3、G4的患者分别为0例、136例、203例、140例、12例，诊断为s0、s1、s2、s3、s4的患者分别为34例、96例、138例、105例、118例。统计分析采用SPSS13．0软件。肝组织不同病理学分级和分期患者性别比例和平均年龄之间的比较分别采用，检验和单因素方差分析；年龄预测肝组织不同炎症活动度和纤维化程度的评价采用ROC曲线法。结果不同病理学分级和分期患者的性别比例之间均无显著性差异（P〉0．05），不同病理学分级和分期患者的平均年龄之间均有显著性差异（P〈0．01）。根据ROC曲线，年龄对轻度和中度炎症没有预测意义；预测重度炎症（=G4）和显著肝纤维化（≥s2）、严重肝纤维化（≥s3）、肝硬化（=s4）的最佳截断值均为42．5岁，其对应的预测重度炎症的灵敏度、特异度和准确度分别为0．917、O．685和0．690，预测显著纤维化的灵敏度、特异度和准确度分别为0．368、0．777和0．477，预测严重纤维化的灵敏度、特异度和准确度分别为0．439、0．761和0．615，预测肝硬化的灵敏度、特异度和准确度分别为0．534、0．735和0．686。结论性别对慢性乙型肝炎肝组织病理学状态没有预测意义，年龄对慢性乙型肝炎肝组织炎症活动度和纤维化程度有一定预测价值。

Valuation of sex and age for predicting hepatic pathological status in patients with chronic hepatitis B

Objective To explore the valuation of the sex and age for predicting the hepatic inflammatory activities and fibrotic levets in patients with chronic hepatitis B. Methods 491 consecutive patients with chronic hepatitis B were enrolled in present study, in which 0 patients, 136 patients, 203 patients, 140 patients, 12 patients were pathologically diagnosed as G0, G1, G2, G3, G4, respectively; and 34 patients, 96 patients, 138 patients, 105 patients, 118 patients were pathologically diagnosed as S0, S1, s2, s3, s4, respectively. SPSS 13.0 software was used for statistical analyses, x2 tests and one-way ANOVA were used for comparison of the sex ratios and the mean ages in patients with different pathological grading and staging, respectively. ROC curve methods were used for appraisement of the age for predicting different hepatic inflammatory activities and fibrotic levels, Results There were no significant differences of the sex ratios in patients with different pathological grading and staging （P〉0.05）, and there were significant differences of the mean ages in patients with different pathological grading and staging （P〈0.01）. According the ROC curves, the age had no significance for predicting the mild inflammation （≥G2） and moderate inflammation （≥G3）; All the optimal cutoffs were 42.5 years for predicting severe inflammation （ = G4）, significant fibrosis （≥s2）, severe fibrosis （≥s3）, cirrhosis （= s4）; the corresponding sensitivity, specificity and accuracy for predicting severe inflammation were 0.917, 0.685 and 0.690; for predicting significant fibrosis were 0.368, 0.777 and 0.477; for