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目的在慢性乙型肝炎病毒(HBV)感染患者中评价肝纤维化非创伤性诊断模型的诊断价值,为其在临床诊疗上的应用提供参考。方法对131例慢性HBV感染患者进行肝活检的病理学分级、分期,并检测血清指标以计算S指数、SLFG模型、Hepascore、Forns指数和APRI指数等诊断模型。用受试者工作曲线(ROC)等方法验证和比较各模型的诊断价值。结果各指标组合模型对肝纤维化程度都具有一定诊断价值。其中由γ-谷氨酰转肽酶(GGT)、血小板(PLT)和白蛋白(Alb)三个常规指标组成的S指数在验证组中表现最佳[S指数=1000×GGT/(PLT×Alb2)]。其判断有无明显肝纤维化、有无重度肝纤维化和有无早期肝硬化时的ROC曲线下面积(AUC)分别达0.797、0.880和0.881。以S指数<0.1预测无明显肝纤维化,S指数≥0.5预测存在明显肝纤维化,验证组中40.5%病例可被正确预测。以S指数<0.3预测无早期肝硬化,S指数≥1.5预测存在早期肝硬化,验证组中68.7%病例可被正确预测。结论肝纤维化非创伤性诊断模型能较好地区分存在明显肝纤维化或早期肝硬化的慢性HBV感染患者,其中以S指数最为简便有效,它的应用可以减少一部分慢性HBV感染患者肝活检的需要。
Objective To evaluate the diagnostic value of noninvasive diagnostic model of liver fibrosis in patients with chronic hepatitis B virus infection and provide reference for its clinical application. Methods 131 cases of chronic HBV infection were pathologically graded and staged for liver biopsy. Serum indexes were measured to calculate the S index, SLFG model, Hepascore, Forns index and APRI index. The receiver operating curve (ROC) and other methods to verify and compare the diagnostic value of each model. Results The combined model of each index had a certain diagnostic value on the degree of liver fibrosis. Among them, S index composed of GGT, platelet (PLT) and albumin (Alb) showed the best performance in the validation group [S index = 1000 × GGT / (PLT × Alb2)]. The areas under the curve of ROC (AUC) were 0.797, 0.880 and 0.881 respectively for determining whether there was obvious liver fibrosis, with or without severe hepatic fibrosis and with or without early cirrhosis. No significant liver fibrosis was predicted with a S-score <0.1, and significant liver fibrosis was predicted with a S-score ≥0.5, with 40.5% of cases in the validation group correctly predicted. Early cirrhosis was predicted with an S-score <0.3, with an S-score ≥ 1.5 to predict early cirrhosis, and 68.7% of cases in the validation group were correctly predicted. Conclusion The noninvasive diagnostic model of liver fibrosis can distinguish the chronic HBV infection patients with obvious liver fibrosis or early liver cirrhosis. The S index is the most simple and effective, and its application can reduce the risk of liver biopsy in some patients with chronic HBV infection need.