GP模型对ALT小于2倍正常值上限的慢性HBV感染者肝纤维化的诊断价值

张杰灵; 邹桂舟; 郜玉峰; 李家斌

doi:10.3969/j.issn.1001-5256.2020.05.016

GP模型对ALT小于2倍正常值上限的慢性HBV感染者肝纤维化的诊断价值

DOI: 10.3969/j.issn.1001-5256.2020.05.016

1. 安徽医科大学第二附属医院感染病科
2. 安徽医科大学第一附属医院感染病科

基金项目:

安徽省中央引导地方科技发展项目（201907d07050008）；合肥市借转补基金项目（J2019Y04）；

详细信息

中图分类号: R512.62;R575.2
计量
- 文章访问数: 900
- HTML全文浏览量: 56
- PDF下载量: 166
- 被引次数: 0
出版历程
- 收稿日期: 2019-10-24
- 出版日期: 2020-05-20

Value of globulin-platelet model in diagnosis of liver fibrosis in patients with chronic hepatitis B virus infection and alanine aminotransferase <2 ×upper limit of normal

Department of Infectious Diseases,The Second Affiliated Hospital of Anhui Medical University

Research funding:

摘要

摘要:
目的探讨GP模型对ALT <2倍正常值上限（ULN）的慢性HBV感染者肝纤维化程度的诊断价值。方法回顾性分析2010年1月-2018年12月在安徽医科大学第二附属医院接受肝穿刺活组织检查且ALT <2×ULN的659例慢性HBV感染患者的临床资料。根据肝穿刺病理将患者的肝纤维化程度分为显著肝纤维化（≥S2）、严重肝纤维化（≥S3）和肝硬化（S4）,通过患者球蛋白（Glb）、PLT计算GP模型值,应用受试者工作特征曲线（ROC曲线）评估GP模型诊断肝纤维化程度的临床价值,并与经典的APRI评分和FIB-4指数比较。计量资料符合正态分布的多组间比较采用方差分析,不符合正态分布的多组间比较采用KruskalWallisH秩和检验;计数资料多组间比较采用χ2检验。采用Spearman相关分析评估无创模型与肝纤维化分期的相关性。结果 GP模型值在不同肝纤维化程度的患者间差异显著（χ2=126. 960,P<0. 001）。随着肝纤维化程度的加重,GP模型值逐渐升高,GP模型与肝纤维化程度呈显著正相关（r=0.401,P<0. 0...
- 肝炎,乙型,慢性 /
- 肝硬化 /
- 诊断
Abstract:
Objective To investigate the value of globulin-platelet(GP) model in the diagnosis of liver fibrosis in patients with chronic hepatitis B virus(HBV) infection and alanine aminotransferase(ALT)<2 ×upper limit of normal(ULN).Methods A retrospective analysis was performed for the clinical data of 659 patients with chronic HBV infection who underwent liver biopsy in The Second Affiliated Hospital of Anhui Medical University from January 2010 to December 2018 and had an ALT level of <2 ×ULN. Based on the results of liver biopsy, the patients were divided into marked liver fibrosis(S≥2) group, severe liver fibrosis(S≥3) group, and liver cirrhosis(S4)group. The levels of globulin and platelets were measured to calculate the value of GP model, the receiver operating characteristic(ROC)curve was used to evaluate the clinical value of GP model in the diagnosis of liver fibrosis, and the GP model was compared with aspartate aminotransferase to platelet ratio index(APRI) and fibrosis-4(FIB-4). An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-WallisHtest was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between multiple groups; a Spearman correlation analysis was used to investigate the correlation between noninvasive models and liver fibrosis stage.Results There was a significant difference in the value of GP model between the patients with different degrees of liver fibrosis (χ2= 126. 960,P< 0. 001). The value of GP model gradually increased with the aggravation of liver fibrosis, suggesting that the value of GP model was positively correlated with the degree of liver fibrosis(r =0.401,P< 0. 01). Globulin, APRI score, and FIB-4 index were positively correlated with the degree of liver fibrosis(r =0. 125, 0. 452, and 0. 414, allP<0. 01), and platelet was negatively correlated with the degree of liver fibrosis(r =-0.390,P<0. .="" gp="" model="" had="" similar="" areas="" under="" the="" roc="" curve="" to="" apri="" score="" and="" fib-4="" index="" in="" diagnosis="" of="" marked="" liver="" severe="" 0.834="" vs="" 0.824="" allp="">0. 05).Conclusion For patients with chronic HBV infection and ALT < 2 × ULN, GP model is a simple and accurate noninvasive assessment model forliver fibrosis, with a similar clinical value to APRI score and FIB-4 index.
- hepatitis B,chronic /
- liver cirrhosis /
- diagnosis

HTML全文

参考文献(16)

[1] de LÉDINGHEN V, VERGNIOL J, BARTHE C, et al. Noninvasive tests for fibrosis and liver stiffness predict 5-year survival of patients chronically infected with hepatitis B virus[J].Aliment Pharm Ther, 2013, 37(10):979-988.

[2] TESHALE E, LU M,RUPP LB,et al. APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B:The Chronic Hepatitis Cohort Study(CHeCS)[J]. J Viral Hepat, 2014, 21(12):917-920.

[3] JIN CT, GUO LW, LIANG WF. Research progress on non-invasive serum markers for liver fibrosis assessment in patients with chronic hepatitis B[J/CD]. Chin J Exp Clin Infect Dis:Electronic Edition, 2018, 12(1):11-14.(in Chinese）金彩婷，郭利伟，梁伟峰．慢性乙型病毒性肝炎肝纤维化无创性血清诊断指标研究进展[J/CD]．中华实验和临床感染病杂志（电子版），2018, 12(1):11-14.

[4] LIU XD, WU JL, LIANG J, et al. Globulin-platelet model predicts minimal fibrosis and cirrhosis in chronic hepatitis B virus infected patients[J]. World J Gastroenterol, 2012, 18(22):2784-2792.

[5] COSKUN BD, ALTINKAYA E, SEVINC E, et al. The diagnostic value of a globulin/platelet model for evaluating liver fibrosis in chronic hepatitis B patients[J]. Rev Esp Enferm Dig, 2015,107(12):740-744.

[6] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J]. J Clin Hepatol, 2011, 27(1）：Ⅰ-Ⅻ．（in Chinese）中华医学会肝病学分会，中华医学会感染病学分会．慢性乙型肝炎防治指南（2010年版）[J]．临床肝胆病杂志，2011, 27(1）：Ⅰ-Ⅻ．

[7] Chinese Society of Infectious Diseases and Parasitology, Chinese Society of Hepatology, Chinese Medical Association.The program of prevention and cure for viral hepatitis[J]. Chin J Intern Med, 2001, 40(1):62-68.(in Chinese）中华医学会传染病与寄生虫病学分会，肝病学分会．病毒性肝炎防治方案[J]．中华内科杂志，2001, 40(1):62-68.

[8] GUO YC, LU LG. Role of monocyte chemoattractant protein 1and its receptor in the progression of liver fibrosis[J]. J Clin Hepatol, 2019, 35(12):2793-2795.(in Chinese）郭悦承，陆伦根．单核细胞趋化蛋白-1及其受体在肝纤维化进程中的作用[J]．临床肝胆病杂志，2019, 35(12):2793-2795.

[9] CHEN EQ, HUANG FJ, HE LL, et al. Histological changes in Chinese chronic hepatitis B patients with ALT lower than two times upper limits of normal[J]. Dig Dis Sci, 2010, 55(2):432-437.

[10] LI W, XU KH, ZHAO SS. Association between liver pathology and clinical features in patients with chronic HBV infection and slightly elevated alanine aminotransferase[J]. J Clin Hepatol,2017, 33(11):2123-2126.(in Chinese）李伟，徐葵花，赵守松．ALT轻度升高的慢性HBV感染者临床特征与病理学的关系[J]．临床肝胆病杂志，2017, 33(11):2123-2126.

[11] CUI WJ, ZHU FQ. Research progress on influencing factors of thrombocytopenia in chronic hepatitis B cirrhosis[J]. J Pract Hepatol, 2010, 13(1):78-80.(in Chinese）崔文娟，朱凤群．慢性乙型肝炎肝硬化PLT减少影响因素的研究进展[J]．实用肝脏病杂志，2010, 13(1):78-80.

[12] SCHMILOVITZ-WEISS H, TOVAR A, HALPERN M, et al.Predictive value of serum globulin levels for the extent of hepatic fibrosis in patients with chronic hepatitis B infection[J].J Viral Hepat, 2010, 13(10):671-677.

[13] LEE J, KIM MY, KANG SH, et. al. The gamma-glutamyl transferase to platelet ratio and the FIB-4 score are noninvasive markers to determine the severity of liver fibrosis in chronic hepatitis B infection[J]. Brit J Biomed Sci, 2018, 75(3):128-132.

[14] LIU YR, ZENG DW, CUI SH, et al. Validation of a noninvasive diagnostic model for liver cirrhosis in patients with chronic hepatitis B[J]. Chin J Infect, 2013, 31(12):719-723.(in Chinese）刘豫瑞，曾达武，崔首华，等．慢性乙型肝炎患者肝硬化无创诊断模型的验证[J]．中华传染病杂志，2013, 31(12):719-723.

[15] LI Q, LU C, LI W, et al. Globulin-platelet model predicts significant fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase levels[J]. Clin Exp Med, 2018, 18(1):71-78.

[16] XU J, GAO XW, LI SS, et al. Clinical value of GP model in diagnosis of hepatic fibrosis in patients with chronic HBV infection[J]. Chin J Integr Tradit West Med Liver Dis, 2019, 29(4):334-336.(in Chinese）徐静，高学武，李莎莎，等．GP模型诊断HBV慢性感染者肝纤维化程度的临床价值[J]．中西医结合肝病杂志，2019, 29(4):334-336.

施引文献

资源附件(0)

访问统计