谷氨酰转肽酶/HBsAg比值评估慢性乙型肝炎患者肝纤维化的价值探讨

摘要

Objective To assess the liver fibrosis by serum gama-glutamyltransferase (γ-GT) and HBsAg quantification (qHBsAg) ratio (GqHBsR) in patients with chronic hepatitis B. Methods A total of 232 patients with chronic hepatitis B were enrolled and all had liver biopsied. Serum γ-GT and HBsAg were detected. Liver fibrosis was believed to be significant as ≥S2 and to be mild or without fibrosis as less than S2 existed. Diagnos-tic efficacy of GqHBsR was assessed at different cut-off values for significant liver fibrosis by using receiver op-erating characteristic (ROC) curves. Results The area under ROC (AUC) of GqHBsR for significant liver fibro-sis was 0.704. When the GqHBsR was greater than 9.570 for significant liver fibrosis,the sensitivity,specificity, positive predictive value (PPV) and negative predictive value (NPV) were 49.2%,88.2%,84.2% and 57.7%;When the GqHBsR was >10 for significant liver fibrosis,the specificity and PPV were 88.2% and 83.3%,respectively;When the GqHBsR was>20 for significant liver fibrosis,specificity and PPV were both 100%;When the GqHBsR was <2.4 for significant liver fibrosis,the sensitive and NPV were 98.4% and 81.8%,respectively;When the GqHB-sR was <2 for significant liver fibrosis,the sensitive and NPV were both 100%;The area under ROC (AUC) of fi-brosis index based on the 4 factor(FIB-4),aspartate aminotransferase to platelet ratioindex(APRI),γ-GT and HB-sAg for significant liver fibrosis were 0.638,0.631,0.606 and 0.588,respectively,all were less efficient as compared to that of GqHBsR. Conclusion GqHBsR yields a higher AUC than aspartate aminotransferase to platelet ratio index,FIB-4,γ-GT or HBsAg. This noninvasive diagnostic models for determination of liver fibrosis might be use-ful in clinical practice.%目的：评价血清γ-谷氨酰转肽酶（γ-GT）与HBsAg定量比值（GqHBsR）判断慢性乙型肝炎患者肝纤维化程度的价值。方法在232例进行肝穿刺的慢性乙型肝炎患者，采用美国罗氏公司提供的化学发光法试剂检测HBsAg定量；将≥S2作为显著纤维化组，＜S2组作为轻度或无纤维化组，采用受试者工作特征曲线（ROC）评价该比值在不同截点时对于显著性肝纤维化的诊断价值。结果 GqHBsR判断有无显著性肝纤维化时的ROC曲线下面积（AUC）为0.704。当GqHBsR>9.57时，诊断显著肝纤维化的敏感性为49.2%、特异性为88.2%、阳性预测值（PPV）为84.2%、阴性预测值（NPV）为57.7%；当GqHBsR>10时，其特异性和PPV分别为88.2%和83.3%；当GqHBsR＞20时，其特异性和PPV均为100%；当GqHBsR＜2.4时，其敏感性和阴性预测值分别为98.4%和81.8%；当GqHBsR＜2时，其敏感性和阴性预测值均为100%。随着GqHBsR逐渐增大，其特异性和PPV逐渐增大，随着GqHBsR逐渐变小，其敏感性和NPV逐渐增大。在特异性和PPV分别为88.2%和83.3%，敏感性和NPV分别为98.4%和81.8%时，可避免约40%患者进行肝穿刺。基于4因素的肝纤维化指数（FIB-4）、天冬氨酸氨基转移酶与血小板比值（APRI）、γ-GT、HBsAg单独判断有无显著性肝纤维化的 AUC 分别为0.638、0.631、0.606、0.588，而GqHBsR判断有无显著性肝纤维化的AUC明显优于FIB-4、APRI、γ-GT或HBsAg。结论非创伤性诊断模型GqHBsR能较好地区分存在显著性肝纤维化，对于慢性乙型肝炎患者的抗病毒治疗或许有一定的指导意义。