血清糖类抗原19—9对慢性HBV感染患者肝纤维化的预测价值研究(1)
[摘要] 目的 通过分析血清糖类抗原19-9(carbohydrate antigen 19-9，CA19-9)和APRI(aspartate aminotransferase-to-platelet ratio index)评分无创评估慢性HBV感染患者显著肝纤维化的临床价值，探索新的肝纤维化无创诊断指标。 方法 选取2011年10月～2014年10月经肝活检证实的慢性HBV(hepatitis B virus)感染患者410例，检测所有患者血清CA19-9和其他实验室指标，计算APRI评分。所有患者按肝脏纤维化程度分为两组：276例轻度肝纤维化(S0～S1)和134例显著肝纤维化(S2～S4)，比较不同肝纤维化程度患者血清CA19-9和APRI评分的差异。并采用ROC(Receiver Operating Characteristic)曲线评价血清CA19-9及APRI评分单项及联合应用对显著肝纤维化的诊断价值。 结果 血清CA19-9浓度和APRI评分随着肝脏纤维化程度的加深而逐渐升高，且在S0-S4组中的总体差异均有统计学意义(P均<0.05)。血清CA19-9和APRI评分诊断显著肝纤维化的ROC曲线下面积(AUC)分别为0.70(0.65～0.76)、0.76(0.71～0.81)。对血清CA19-9和APRI评分进行多因素Logistic回归分析构建联合预测模型，其AUC达到0.80。 结论 血清CA19-9对慢性HBV感染患者显著肝纤维化的诊断有一定的临床应用价值，与其他指标的联合应用可以有效提高诊断效率。
[关键词] 慢性乙型肝炎；糖类抗原19-9；肝纤维化；APRI
[中图分类号] R512.62 [文献标识码] B [文章编号] 1673-9701(2016)15-0102-04
[Abstract] Objective To analyze the clinical value of serum CA19-9 and APRI scoring system on noninvasive assessment in chronic HBV infected patients with significant liver fibrosis， and to explore new noninvasive diagnostic indicators. Methods 410 cases of chronic HBV infected patients confirmed by liver biopsy were enrolled from October 2011 to October 2014， and serum CA19-9 and other laboratory indicators in all patients were detected，from which APRI score was calculated. All patients were divided into two groups based on liver fibrosis： 276 cases of mild fibrosis(S0-S1) and 134 cases of significant liver fibrosis(S2 to S4)，and the differences of serum CA19-9 and APRI score were compared among the patients with different liver fibrosis. The individual and combined diagnostic value of serum CA19-9 and APRI score for significant liver fibrosis was evaluated by ROC curve. Results Serum CA19-9 concentration and APRI score gradually increased with liver fibrosis deepening， among the patients with different liver fibrosis. The area under the ROC curve(AUC) of serum CA19-9 and APRI score for the diagnosis of significant fibrosis were 0.70 (0.65 to 0.76) and 0.76(0.71 to 0.81). Multivariate logistic regression analysis was made on serum CA19-9 and APRI score to build a joint prediction model， and its AUC was 0.80. Conclusion Serum CA19-9 has some clinical value for the diagnosis of significant liver fibrosis in chronic HBV infected patient， and the diagnostic efficiency can be improved through combinating other indicators.
[Key words] Chronic hepatitis B； Carbohydrate antigen (CA19-9)； Liver fibrosis； APRI
乙型肝炎病毒(hepatitis B virus，HBV)是人类传染病的主要病原体之一，全世界HBV慢性携带者超过2.4亿[1]，而中国约有9300万人[2]。慢乙肝引起肝细胞慢性损伤，纤维合成增多而降解减少导致肝脏纤维化。肝组织活检一般被认为是评估组织损伤程度(包括肝纤维化)的参考方法，但其存在诸多不足，比如有创伤性、不能反复检查、病变在肝脏内不均匀、存在观察者自身和观察者之间的差异等[3]。因此，探索简便、易开展的无创检测方法来诊断和评估慢性肝病患者肝脏纤维化一直临床关注的焦点之一。在多个基于血清学指标的肝纤维化无创诊断模型中，包括采用慢性HCV感染患者建立模型的APRI(aspartate aminotransferase-to-platelet ratio index)指数、Forns指数、Fibrotest和Hepascore等是其中的代表，但文献报道的临床应用价值高低不一[4-9]。近年来，国外有文献报道血清糖类抗原19-9(carbohydrate antigen 19-9，CA19-9)与肝脏炎症轻重和纤维化程度有密切的关系[10]，而国内鲜有相关研究。本文主要探讨血清CA19-9与慢乙肝肝纤维化的关系，并与APRI指数比较，尝试通过联合检测提高诊断显著肝纤维化的效率。, http://www.100md.com(卢勤红 高国生 胡爱荣 董飞波 胡耀仁 )
[关键词] 慢性乙型肝炎；糖类抗原19-9；肝纤维化；APRI
[中图分类号] R512.62 [文献标识码] B [文章编号] 1673-9701(2016)15-0102-04
[Abstract] Objective To analyze the clinical value of serum CA19-9 and APRI scoring system on noninvasive assessment in chronic HBV infected patients with significant liver fibrosis， and to explore new noninvasive diagnostic indicators. Methods 410 cases of chronic HBV infected patients confirmed by liver biopsy were enrolled from October 2011 to October 2014， and serum CA19-9 and other laboratory indicators in all patients were detected，from which APRI score was calculated. All patients were divided into two groups based on liver fibrosis： 276 cases of mild fibrosis(S0-S1) and 134 cases of significant liver fibrosis(S2 to S4)，and the differences of serum CA19-9 and APRI score were compared among the patients with different liver fibrosis. The individual and combined diagnostic value of serum CA19-9 and APRI score for significant liver fibrosis was evaluated by ROC curve. Results Serum CA19-9 concentration and APRI score gradually increased with liver fibrosis deepening， among the patients with different liver fibrosis. The area under the ROC curve(AUC) of serum CA19-9 and APRI score for the diagnosis of significant fibrosis were 0.70 (0.65 to 0.76) and 0.76(0.71 to 0.81). Multivariate logistic regression analysis was made on serum CA19-9 and APRI score to build a joint prediction model， and its AUC was 0.80. Conclusion Serum CA19-9 has some clinical value for the diagnosis of significant liver fibrosis in chronic HBV infected patient， and the diagnostic efficiency can be improved through combinating other indicators.
[Key words] Chronic hepatitis B； Carbohydrate antigen (CA19-9)； Liver fibrosis； APRI
乙型肝炎病毒(hepatitis B virus，HBV)是人类传染病的主要病原体之一，全世界HBV慢性携带者超过2.4亿[1]，而中国约有9300万人[2]。慢乙肝引起肝细胞慢性损伤，纤维合成增多而降解减少导致肝脏纤维化。肝组织活检一般被认为是评估组织损伤程度(包括肝纤维化)的参考方法，但其存在诸多不足，比如有创伤性、不能反复检查、病变在肝脏内不均匀、存在观察者自身和观察者之间的差异等[3]。因此，探索简便、易开展的无创检测方法来诊断和评估慢性肝病患者肝脏纤维化一直临床关注的焦点之一。在多个基于血清学指标的肝纤维化无创诊断模型中，包括采用慢性HCV感染患者建立模型的APRI(aspartate aminotransferase-to-platelet ratio index)指数、Forns指数、Fibrotest和Hepascore等是其中的代表，但文献报道的临床应用价值高低不一[4-9]。近年来，国外有文献报道血清糖类抗原19-9(carbohydrate antigen 19-9，CA19-9)与肝脏炎症轻重和纤维化程度有密切的关系[10]，而国内鲜有相关研究。本文主要探讨血清CA19-9与慢乙肝肝纤维化的关系，并与APRI指数比较，尝试通过联合检测提高诊断显著肝纤维化的效率。, http://www.100md.com(卢勤红 高国生 胡爱荣 董飞波 胡耀仁 )