Abstract：Objective To explore the diagnostic value of liver fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) among the aspartate aminotransferase / platelet ratio (APRI), cirrhosis discriminant score (CDS), and fibrosis index based on the four factors (FIB-4), Forns index, glutamyltransferase / platelet ratio (GPR), King’s score, S index model for chronic. Methods From January 2019 to December 2020, a total of 166 patients with CHB who were admitted to Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine and underwent liver biopsy and blood biochemical coagulation tests were selected. According to the liver fibrosis stage (S) of the liver biopsy results, there were 55 cases in the non-obvious liver fibrosis group (S0-1), 97 cases in the significant liver fibrosis group (S2-3), and 14 cases in the early-stage cirrhosis group (S4). The APRI, CDS, FIB-4, Forns index, GPR, King’s score, and S index according to the formula were calculate. At the same time, the receiver operating characteristic (ROC) curves of the above seven models were drawn, and the area under the ROC curve (AUC), sensitivity, and specificity were calculated to evaluate the value of each model in the diagnosis of liver fibrosis. Results Compared with the three groups of model scores, and the difference was highly statistically significant (P ＜ 0.01). Except for the CDS model, each model index was positively correlated with the inflammation grade (r ＞ 0, P ＜ 0.05); the scores of each model were positively correlated with liver fibrosis stage (r ＞ 0, P ＜ 0.05). The AUC of S index, APRI, GPR, and King’s score for the diagnosis of significant liver fibrosis＞0.7. The AUC for the diagnosis of early liver cirrhosis from high to low as GPR, S index, APRI, Forns index, King’s score, CDS, and FIB-4. The AUC analysis of the seven models showed that there was a statistically significant difference between APRI and King’s score in the significant liver fibrosis group (Z = 2.197, P ＜ 0.05); there was no significant difference between the other models (P ＞ 0.05). Conclusion APRI, GPR, King’s score, and S index can better diagnose significant liver fibrosis and early cirrhosis in CHB patients. CDS, FIB-4, Forns index have certain diagnostic value for early liver cirrhosis, but the diagnostic accuracy for significant liver fibrosis is low. APRI and GPR models are simple to calculate, serological indicators are readily available, and the cost is low. It can be recommended as a detection method for liver fibrosis in patients with CHB in the grassroots and areas with limited medical resources, so that some patients can avoid invasive liver biopsy and reduce medical costs.
吴小溪 汪涛 杜晟楠 蒋元烨▲ 曹勤▲. 7种无创诊断模型对慢性乙型肝炎肝纤维化及肝硬化的诊断价值评估[J]. 中国医药导报, 2022, 19(10): 14-19.
WU Xiaoxi WANG Tao DU Shengnan JIANG Yuanye▲ CAO Qin▲. Diagnostic value assessment of seven noninvasive diagnostic models in liver fibrosis and cirrhosis of patients with chronic hepatitis B#br#. 中国医药导报, 2022, 19(10): 14-19.
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