【摘要】 目的探究肝纤维化指数(FIB-4)、天冬氨酸氨基转移酶-血小板比率指数(APRI)和球蛋白-血小板指数(GPI)三种模型对自身免疫性肝炎(AIH)显著肝纤维化的诊断价值。方法收集2011年11月-2019年5月在安徽医科大学第一附属医院住院且经肝活检确诊的47例AIH患者,以年龄与性别相匹配的47例健康人群作为对照组,依据病理结果将AIH患者分为两组:S1为轻度肝纤维化(n=16),S2～S4为显著肝纤维化(n=31)。观察两组间年龄、血常规和生化等指标差异,计算FIB-4、APRI和GPI并进行比较分析。正态分布的计量资料两组间比较采用独立样本t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U检验。单因素分析采用二元logistic回归法,分析显著肝纤维化的影响因素;并根据受试者工作特征曲线下面积(AUC)比较各模型的诊断价值。结果与对照组相比,AIH组的Glo、ALT、AST、ALP、GGT、FIB-4、APRI和GPI水平均升高,PLT和Alb水平均降低,差异均有统计学意义(P值均<0.05)。与轻度肝纤维化相比,显著肝纤维化患者年龄、FIB-4和GPI水平均显著升高(t=-2.681、Z=-3.053、Z=-3.457,P值分别为0.010、0.002、0.001),PLT、GGT显著降低(t=3.185、Z=-2.290,P值分别为0.003、0.022)。单因素分析结果显示,年龄(OR=1.074,95%CI:1.013～1.139,P=0.017)、PLT(OR=0.987,95%CI:0.978～0.997,P=0.010)、FIB-4(OR=1.339,95%CI:1.046～1.713,P=0.021)和GPI(OR=4.449,95%CI:1.319～15.008,P=0.016)为AIH显著肝纤维化的影响因素。FIB-4和PLT诊断AIH显著肝纤维化的AUC分别为0.774、0.746; GPI诊断AIH显著肝纤维化的AUC为0.810,敏感度为83.9%,特异度为81.2%,阳性预测值为89.7%,阴性预测值为72.2%,优于FIB-4和PLT; APRI对AIH显著肝纤维化无诊断价值(P=0.271)。结论 GPI模型对AIH显著肝纤维化具有一定的预测价值,有助于减少部分患者对肝活检的需求。更多还原

【Abstract】 Objective To investigate the value of fibrosis-4( FIB-4),aspartate aminotransferase-to-platelet ratio index( APRI),and globulin-platelet index( GPI) in the diagnosis of significant liver fibrosis in autoimmune hepatitis( AIH). Methods A total of 47 AIH patients who were hospitalized and underwent liver biopsy in The First Affiliated Hospital of Anhui Medical University from November 2011 to May 2019 were enrolled as AIH group,and 47 healthy individuals,matched for age and sex,were enrolled as control group. According to the pathological results,AIH patients were divided into mild liver fibrosis( S1) group with 16 patients and significant liver fibrosis( S2-S4) group with 31 patients. The two groups were compared in terms of age,routine blood test results,and biochemical indices,and FIB-4,APRI,and GPI were calculated and compared between the two groups. The independent samples t-test was used for comparison of normally distributed continuous data between the two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between the two groups. A univariate binary logistic regression analysis was used to investigate the risk factors for significant liver fibrosis,and the area under the receiver operating characteristic curve( AUC) was used to compare the diagnostic value of each model. Results Compared with the control group,the AIH group had significant increases in globulin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,gamma-glutamyl transpeptidase( GGT),FIB-4,APRI,and GPI and significant reductions in platelet count( PLT) and albumin( all P < 0. 05). Compared with the mild liver fibrosis group,the significant liver fibrosis group had significant increases in age( t =-2. 681,P = 0. 010),FIB-4( Z =-3. 053,P = 0. 002),and GPI( Z =-3. 457,P = 0. 001) and significant reductions in PLT( t = 3. 185,P = 0. 003) and GGT( Z =-2. 290,P = 0. 022). The univariate analysis showed that age( odds ratio[OR]= 1. 074,95% confidence interval [CI]: 1. 013-1. 139,P = 0. 017),PLT( OR = 0. 987,95% CI: 0. 978-0. 997,P = 0. 010),FIB-4( OR = 1. 339,95% CI: 1. 046-1. 713,P = 0. 021),and GPI( OR = 4. 449,95% CI: 1. 319-15. 008,P = 0. 016) were influencing factors for significant liver fibrosis in AIH patients. FIB-4 and PLT had an AUC of 0. 774 and 0. 746,respectively,in the diagnosis of significant liver fibrosis in AIH patients,and GPI had an AUC of 0. 810,a sensitivity of 83. 9%,a specificity of 81. 2%,a positive predictive value of 89. 7%,and a negative predictive value of 72. 2% in the diagnosis of significant liver fibrosis and was superior to FIB-4 and PLT. APRI had no value in the diagnosis of significant liver fibrosis in AIH patients( P = 0. 271). Conclusion GPI has a certain value in predicting significant liver fibrosis in AIH patients and thus helps to reduce the need for liver biopsy in some patients.更多还原