Fibro Test 在慢性乙型肝炎肝纤维化程度判断中的应用

摘要

Objective Objective:To investigate value of FibroTest ( FT) for the evaluation of liver fibrosis in patients with chronic hepatitis B ( CHB) .Methods :Serum specimens from 148 patients with chronic hepatitis B were tested for five indicators including α2-macroglobulin (α2M), haptoglobin (HAP), γ-glutamyl peptidase (GGT), total bilirubin (BIL) and apolipoprotein aⅠ(Apo AⅠ) and calculated the FT values according to the FT model:FT=4.467 × [lgα2M (g/L)]-1.357 ×[lgHAP (g/L)] +1.017 ×[lgGGT (U/L)] +0.0281 ×[Age(?years)] +1.737 ×lg [TBIL(? mol/L)] -1.184 ×[Apo AⅠ(g/L)]+0.301 ×sex ( male =1 , female =0 ) -5.540.The subjects were given liver biopsy during the same period .With liver biopsy as the gold standard , the ROC curves were delineated for dif-ferent endpoints .The area under the curve ( AUC) was calculated to evaluate the determinate value for liver fibrosis in pa-tients with CHB.Results:There were 4 cases in the S0-stage (the pathological stage of liver fibrosis ), 59 cases in the S1-stage, 41cases in the S2-stage, 31cases in the S3 stage and 13 cases in the S4 stage.There were 85 cases of significant fi-brosis,4 cases of severe fibrosis, and 13 cases of early cirrhosis.The FT value of the 148 patients was 0.616 ±1.152, and the FT values of fibrosis pathologic stages from S 0 to S4 were-0.326 ±0.378,-0.167 ±1.145, 0.906 ±0.834, 1.308 ± 0.516, and 1.894 ±0.544 respectively.The FT values of any 2 of the5 Stages (S0-S4) were compared, and all the P val-ues were less than 0.05.There was a positive correlation between the value of FibroTest ?? and liver pathological stage, (r=0.629, p <0.01).For the group of significant fibrosis , severe fibrosis and early cirrhosis , the AUC values of FT were 0.831, 0.889 and 0.945, the cut-off values were 0.403, 0.756 and 1.385, and the diagnostic accuracy rates were 81. 6%, 85.5%and 91.4%respectively.Conclusion:Fibro test has a certain value for the evaluation of liver fibrosis in chro-nic hepatitis .%目的：探讨Fibro Test在慢性乙型肝炎肝纤维化程度判断中的价值。方法留取148例慢性乙型肝炎患者血清，检测α2巨球蛋白（α2M）、结合珠蛋白（HAP）、γ-谷氨酰转肽酶（GGT）、总胆红素（TBIL）和载脂蛋白AⅠ（Apo AⅠ）五个指标，以Fibro Test模型计算FT值，FT＝4．467×[lgα2M （g/L）〗-1．357×[lgHAP （g/L）]＋1．017×[lgGGT （U/L）]＋0．0281×年龄＋1．737×[lgTBIL （mol/L）]-1．184×[Apo AⅠ（g/L）]＋0．301×性别（男性＝1，女性＝0）-5．540。受试者均于同期进行肝穿刺活检。以肝穿刺活检病理结果为金标准，绘制出FT值工作特征曲线，计算曲线下面积（ AUC），评价其在慢性乙型肝炎肝纤维化程度判断中的价值。结果肝脏病理纤维化分期为S0期4例，S1期59例，S2期41例，S3期31例，S4期13例。显著肝纤维化85例，严重肝纤维化44例，早期肝硬化13例。148例患者的 FT 值为0．616±1．152，其中病理纤维化分期为S0、S1、S2、S3、S4期的 FT值分别为-0．326±0．378、-0．167±1．145、0．906±0．834、1．308±0．516、1．894±0．544，S0、S1、S2、S3、S4期的FT值两两比较，P均＜0．05。 FT值与肝脏病理分期呈正相关（r＝0．629，P＜0．01）。 FT值判断显著肝纤维化、严重肝纤维化及早期肝硬化的AUC分别为0．831、0．889、0．945，cut-off值分别为0．403、0．756、1．385，诊断准确率分别为81．6％、85．5％、91．4％。结论 Fibro Test在慢性乙型肝炎肝纤维化程度判断中有一定价值。