摘要
目的 研究瞬时弹性成像技术(TE)和常用的无创诊断模型诊断原发性胆汁性胆管炎(PBC)患者组织学分期的效能.方法 2019年1月～2023年8月首都医科大学附属北京佑安医院就诊的PBC患者117例,均接受肝活检、肝脏硬度检测(LSM)和常规实验室检查,计算天冬氨酸氨基转移酶/血小板比值(APRI)、基于4因子的肝纤维化指数(FIB-4)、γ-谷氨酰转肽酶/血小板比值(GPR)、Sheth指数、King's评分、哥德堡大学肝硬化指数(GUCI)评分、白蛋白-胆红素(ALBI)评分和总胆汁酸-红细胞体积分布宽度(TR)评分.应用ROC曲线分析判断各指标的诊断效能.结果 在117例PBC患者中,病理学诊断Ⅰ期17例,Ⅱ期59例、Ⅲ期34例和Ⅳ期7例;APRI诊断PBC Ⅱ期以上的AUC最大,为0.875(0.776～0.974),其敏感性为75.8％,特异性为87.5％,阳性预测值为76.5％和阴性预测值为87.0％,其次是GUCI评分,其AUC=0.871(0.766～0.976),其效能分别为88.7％、75.0％、65.6％和92.4％.结论 APRI是一种简便、廉价的非侵入性预测指标,用于判断Ⅱ以上PBC患者有良好的诊断效能,值得临床扩大验证.
Abstract
Objective The aim of this study was to investigate the predictive performance of transient elastography(TE)and other common non-invasive diagnostic models in predicting histological fibrosis staging in patients with primary biliary cholangitis(PBC).Methods This study enrolled 117 patients with PBC in Beijing You'an Hospital,affiliated to Capital Medical University between January 2019 and August 2023,and all patients underwent liver biopsy and liver stiffness measurement(LSM).The aspartate aminotransferase/platelet ratio(APRI),fibrosis index based on the four factors(FIB-4),gamma-glutamyl transferase to platelet ratio(GPR),Sheth index,King's score,Gotebörg university cirrhosis index(GUCI)score,albumin-bilirubin(ALBI)score,total bile acid-red cell volume distribution width(TR)score were calculated.The ROC curve analysis was conducted to evaluate the predictive efficacy of each index.Results Out of the 117 patients with PBC,the histo-pathological examination showed stage Ⅰ in 17 cases,stage Ⅱ in 59 cases,stage Ⅲ in 34 cases and stage Ⅳ in 7 cases;the AUC was 0.875(0.776-0.974)by APRI in predicting the stage Ⅱ and the above disease,with the sensitivity(Se),specificity(Sp),positive predictive value(PPV)and negative predictive value(NPV)of 75.8％,87.5％,76.5％and 87.0％,and the other relatively promising index was the GUCI score,with the AUC of 0.871(0.766-0.976),and Se,Sp,PPV and NPV of 88.7％,75.0％,65.6％and 92.4％,respectively.Conclusion The APRI is a simple and inexpensive non-invasive index with a good diagnostic efficacy in predicting stage Ⅱ or above PBC patients,which needs further clinical investigation.
基金项目
北京市医院管理中心"登峰"人才培养计划项目(DFL20221501)
北京市高层次公共卫生技术人才培养计划项目(2022-2-012)
北京市自然科学基金自助项目(7232081)
维普
万方数据