FibroScan联合GGT/PLT比值预测慢性乙型肝炎患者肝纤维化的初步探讨
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摘要
目的初步探讨FibroScan联合GGT/PLT比值(GPR)预测慢性乙型肝炎(CHB)患者肝纤维化分期的诊断价值。方法选取广州市第八人民医院2012年1月-2016年12月肝活组织检查诊断为CHB患者278例,分析GPR、FibroScan以及二者联合诊断预测纤维化分期(F0～F4)的价值。非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用MannWhitney U检验。相关性分析采用Spearman相关系数。受试者工作特征曲线下面积(AUC)评估肝纤维化分期。结果以肝活组织检查作为金标准,F1～F4期患者分别有50、104、92和32例。随着肝纤维化分期加重,FibroScan检测肝硬度值(LSM)逐渐升高(P值均<0. 05); GPR在肝纤维化F1、F2、F3期逐渐升高(P值均<0. 05)。GPR、FibroScan均与肝纤维化呈正相关(r值分别为0. 419、0. 481,P值均<0. 001); GPR与FibroScan呈正相关(r=0. 436,P <0. 001)。FibroScan与GPR联合预测进展期肝纤维化(≥F3)的诊断效能优于单一FibroScan(AUC:0. 793 vs 0. 739,Z=3. 044,P=0. 002)或GPR(AUC:0. 793 vs 0. 740,Z=2. 389,P=0. 037);二者联合预测明显肝纤维化(≥F2)的诊断效能优于单一GPR(AUC:0. 782 vs 0. 714,Z=2. 130,P=0. 033)。结论 FibroScan与GPR联合诊断对于预测CHB进展期肝纤维化(≥F3)具有优势,初步认为可提高诊断效能。
Objective To investigate the value of FibroScan combined with gamma-glutamyl transpeptidase-to-platelet ratio( GPR) in predicting liver fibrosis stage in patients with chronic hepatitis B( CHB). Methods A total of 278 patients who were diagnosed with CHB by liver biopsy in Guangzhou Eighth People's Hospital from January 2012 to December 2016 were enrolled. The value of GPR and FibroScan used alone or in combination in predicting liver fibrosis stage( F0-F4) was analyzed. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and the Mann-Whitney U test was used for further comparison between two groups. The Spearman's correlation coefficient was used for correlation analysis. The area under the receiver operating characteristic curve( AUC) was used to evaluate liver fibrosis stage. Results With liver biopsy as the gold standard,of all patients,50 had stage F1 fibrosis,104 had stage F2 fibrosis,92 had stage F3 fibrosis,and 32 had stage F4 fibrosis. Liver stiffness measurement by FibroScan gradually increased with the increase in liver fibrosis stage( P < 0. 05),and GPR also increased gradually in patients with stage F1,F2,and F3 liver fibrosis( P < 0. 05). GPR and FibroScan were positively correlated with liver fibrosis( r = 0. 419 and 0. 481,both P < 0. 001),and GPR was positively correlated with FibroScan( r = 0. 436,P < 0. 001). According to AUC,FibroScan combined with GPR had a better diagnostic efficiency than FibroScan( 0. 793 vs 0. 739,Z = 3. 044,P = 0. 002) or GPR( 0. 793 vs 0. 740,Z = 2. 389,P = 0. 037) alone in predicting progressive liver fibrosis( ≥F3); FibroScan combined with GPR had a better diagnostic efficiency than GPR alone( 0. 782 vs0. 714,Z = 2. 130,P = 0. 033) in predicting marked liver fibrosis( ≥F2). Conclusion FibroScan combined with GPR has a certain advantage in predicting progressive liver fibrosis( ≥F3) in CHB patients and can improve diagnostic efficiency.
Objective To investigate the value of FibroScan combined with gamma-glutamyl transpeptidase-to-platelet ratio( GPR) in predicting liver fibrosis stage in patients with chronic hepatitis B( CHB). Methods A total of 278 patients who were diagnosed with CHB by liver biopsy in Guangzhou Eighth People's Hospital from January 2012 to December 2016 were enrolled. The value of GPR and FibroScan used alone or in combination in predicting liver fibrosis stage( F0-F4) was analyzed. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and the Mann-Whitney U test was used for further comparison between two groups. The Spearman's correlation coefficient was used for correlation analysis. The area under the receiver operating characteristic curve( AUC) was used to evaluate liver fibrosis stage. Results With liver biopsy as the gold standard,of all patients,50 had stage F1 fibrosis,104 had stage F2 fibrosis,92 had stage F3 fibrosis,and 32 had stage F4 fibrosis. Liver stiffness measurement by FibroScan gradually increased with the increase in liver fibrosis stage( P < 0. 05),and GPR also increased gradually in patients with stage F1,F2,and F3 liver fibrosis( P < 0. 05). GPR and FibroScan were positively correlated with liver fibrosis( r = 0. 419 and 0. 481,both P < 0. 001),and GPR was positively correlated with FibroScan( r = 0. 436,P < 0. 001). According to AUC,FibroScan combined with GPR had a better diagnostic efficiency than FibroScan( 0. 793 vs 0. 739,Z = 3. 044,P = 0. 002) or GPR( 0. 793 vs 0. 740,Z = 2. 389,P = 0. 037) alone in predicting progressive liver fibrosis( ≥F3); FibroScan combined with GPR had a better diagnostic efficiency than GPR alone( 0. 782 vs0. 714,Z = 2. 130,P = 0. 033) in predicting marked liver fibrosis( ≥F2). Conclusion FibroScan combined with GPR has a certain advantage in predicting progressive liver fibrosis( ≥F3) in CHB patients and can improve diagnostic efficiency.
引文
[1]XU X,SU Y,SONG R,et al.Performance of transient elastography assessing fibrosis of single hepatitis B virus infection:Asystematic review and meta-analysis of a diagnostic test[J].Hepatol Int,2015,9(4):558-566.
[2]LI Y,HUANG YS,WANG ZZ,et al.Systematic review with meta-analysis:The diagnostic accuracy of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B[J].Aliment Pharmacol Ther,2016,43(4):458-469.
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[5]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].JClin Hepatol,2015,31(12):1941-1960.(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(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[6]DONG JJ,GUO HH.Association betweenγ-glutamyl transpeptidase-to-platelet ratio and hepatic fibrosis in patients with chronic hepatitis B[J].J Clin Hepatol,2017,33(3):548-552.(in Chinese)董菁菁,郭宏华.GGT与PLT比值指数对慢性乙型肝炎肝纤维化的诊断价值[J].临床肝胆病杂志,2017,33(3):548-552.
[7]LEMOINE M,SHIMAKAWA Y,NAYAGAM S,et al.The gammaglutamyl transpeptidase to platelet ratio(GPR)predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa[J].Gut,2016,65(8):1369-1376.
[8]WANG RQ,ZHANG QS,ZHAO SX,et al.Gamma-glutamyl transpeptidase to platelet ratio index is a good noninvasive biomarker for predicting liver fibrosis in Chinese chronic hepatitis B patients[J].J Int Med Res,2016,44(6):1302-1313.
[9]HU YC,LIU H,LIU XY,et al.Value of gamma-glutamyltranspeptidase-to-platelet ratio in diagnosis of hepatic fibrosis in patients with chronic hepatitis B[J].World J Gastroenterol,2017,23(41):7425-7432.
[10]LI Y,CAI Q,ZHANG Y,et al.Development of algorithms based on serum markers and transient elastography for detecting significant fibrosis and cirrhosis in chronic hepatitis B patients:Significant reduction in liver biopsy[J].Hepatol Res,2016,46(13):1367-1379.
[11]TERRAULT NA,LOK ASF,McMAHON BJ,et al.Update on prevention,diagnosis,and treatment of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J].Hepatology,2018,67(4):1560-1599.
[12]Expert Committee on Clinical Application of Transient Elastography.Expert consensus on chinical application of transient elastography(TE)(2015)[J/CD].Chin J Liver Dis:Electronic Edition,2015,7(2):12-18.(in Chinese)瞬时弹性成像技术临床应用共识专家委员会.瞬时弹性成像技术(TE)临床应用专家共识(2015年)[J/CD].中国肝脏病杂志:电子版,2015,7(2):12-18.
[13]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:E-lectronic 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.
[14]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].Br J Biomed Sci,2018,75(3):128-132.
[15]LIU DP,LU W,ZHANG ZQ,et al.Comparative evaluation of GPR versus APRI and FIB-4 in predicting different levels of liver fibrosis of chronic hepatitis B[J].J Viral Hepat,2018,25(5):581-589.
[16]HUANG CM,YANG Z,NIE YQ,et al.Value of gamma-glutamyl transpeptidase-to-platelet ratio in predicting liver fibrosis stage in chronic hepatitis B patients in Guangdong,China[J].J Clin Hepatol,2018,34(6):1204-1208.(in Chinese)黄春明,杨湛,聂玉强,等.GGT/PLT比值对广东地区慢性乙型肝炎患者肝纤维化分期的预测价值[J].临床肝胆病杂志,2018,34(6):1204-1208.
[17]ZHAO W,ZHANG SY,LU Y,et al.FibroTouch combined with FIB-4,APRI and GPRI in diagnosis of liver fibrosis[J].Clin Focus,2018,33(2):140-144.(in Chinese)赵文,张思雨,路宇,等.FibroTouch联合FIB-4、APRI及GPRI评估肝纤维化[J].临床荟萃,2018,33(2):140-144.
[2]LI Y,HUANG YS,WANG ZZ,et al.Systematic review with meta-analysis:The diagnostic accuracy of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B[J].Aliment Pharmacol Ther,2016,43(4):458-469.
[3]ZENG X,XU C,HE D,et al.Performance of several simple,noninvasive models for assessing significant liver fibrosis in patients with chronic hepatitis B[J].Croat Med J,2015,56(3):272-279.
[4]TANG QR,HE Q,TANG QY.Research advances in non-invasive diagnosis models for liver fibrosis in chronic hepatitis B[J].JClin Hepatol,2015,31(8):1355-1359.(in Chinese)唐情容,何清,唐奇远.慢性乙型肝炎肝纤维化无创性诊断模型的研究进展[J].临床肝胆病杂志,2015,31(8):1355-1359.
[5]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].JClin Hepatol,2015,31(12):1941-1960.(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(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[6]DONG JJ,GUO HH.Association betweenγ-glutamyl transpeptidase-to-platelet ratio and hepatic fibrosis in patients with chronic hepatitis B[J].J Clin Hepatol,2017,33(3):548-552.(in Chinese)董菁菁,郭宏华.GGT与PLT比值指数对慢性乙型肝炎肝纤维化的诊断价值[J].临床肝胆病杂志,2017,33(3):548-552.
[7]LEMOINE M,SHIMAKAWA Y,NAYAGAM S,et al.The gammaglutamyl transpeptidase to platelet ratio(GPR)predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa[J].Gut,2016,65(8):1369-1376.
[8]WANG RQ,ZHANG QS,ZHAO SX,et al.Gamma-glutamyl transpeptidase to platelet ratio index is a good noninvasive biomarker for predicting liver fibrosis in Chinese chronic hepatitis B patients[J].J Int Med Res,2016,44(6):1302-1313.
[9]HU YC,LIU H,LIU XY,et al.Value of gamma-glutamyltranspeptidase-to-platelet ratio in diagnosis of hepatic fibrosis in patients with chronic hepatitis B[J].World J Gastroenterol,2017,23(41):7425-7432.
[10]LI Y,CAI Q,ZHANG Y,et al.Development of algorithms based on serum markers and transient elastography for detecting significant fibrosis and cirrhosis in chronic hepatitis B patients:Significant reduction in liver biopsy[J].Hepatol Res,2016,46(13):1367-1379.
[11]TERRAULT NA,LOK ASF,McMAHON BJ,et al.Update on prevention,diagnosis,and treatment of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J].Hepatology,2018,67(4):1560-1599.
[12]Expert Committee on Clinical Application of Transient Elastography.Expert consensus on chinical application of transient elastography(TE)(2015)[J/CD].Chin J Liver Dis:Electronic Edition,2015,7(2):12-18.(in Chinese)瞬时弹性成像技术临床应用共识专家委员会.瞬时弹性成像技术(TE)临床应用专家共识(2015年)[J/CD].中国肝脏病杂志:电子版,2015,7(2):12-18.
[13]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:E-lectronic 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.
[14]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].Br J Biomed Sci,2018,75(3):128-132.
[15]LIU DP,LU W,ZHANG ZQ,et al.Comparative evaluation of GPR versus APRI and FIB-4 in predicting different levels of liver fibrosis of chronic hepatitis B[J].J Viral Hepat,2018,25(5):581-589.
[16]HUANG CM,YANG Z,NIE YQ,et al.Value of gamma-glutamyl transpeptidase-to-platelet ratio in predicting liver fibrosis stage in chronic hepatitis B patients in Guangdong,China[J].J Clin Hepatol,2018,34(6):1204-1208.(in Chinese)黄春明,杨湛,聂玉强,等.GGT/PLT比值对广东地区慢性乙型肝炎患者肝纤维化分期的预测价值[J].临床肝胆病杂志,2018,34(6):1204-1208.
[17]ZHAO W,ZHANG SY,LU Y,et al.FibroTouch combined with FIB-4,APRI and GPRI in diagnosis of liver fibrosis[J].Clin Focus,2018,33(2):140-144.(in Chinese)赵文,张思雨,路宇,等.FibroTouch联合FIB-4、APRI及GPRI评估肝纤维化[J].临床荟萃,2018,33(2):140-144.