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©The Author(s) 2020.
世界华人消化杂志. 2020-11-28; 28(22): 1137-1144
在线出版 2020-11-28. doi: 10.11569/wcjd.v28.i22.1137
在线出版 2020-11-28. doi: 10.11569/wcjd.v28.i22.1137
API | CDS | ||||
年龄(岁) | PLT (109/L) | AST/ALT | PLT (109/L) | INR | |
0 | <30 | ≥225 | >1.7 | ≥340 | <1.1 |
1 | 30-39 | 224-200 | 1.2-1.7 | 280-339 | 1.1-1.4 |
2 | 40-49 | 199-175 | 0.6-1.19 | 220-279 | >1.4 |
3 | 50-59 | 174-150 | <0.6 | 160-219 | NA |
4 | 60-69 | 149-125 | NA | 100-159 | NA |
5 | ≥70 | <125 | NA | 40-99 | NA |
6 | NA | NA | NA | <40 | NA |
表2 各指标在不同肝纤维化分期的特点 [M (P25-P75)]
模型 | F0-1 (435例) | F2 (219例) | F3 (177例) | F4 (199例) | χ2 | P值 |
年龄(岁) | 28.0 (22.0-36.0) | 36.0 (27.0-43.0) | 36.0 (29.0-45.0) | 40.0 (35.0-50.0) | 161.1 | 0.000 |
血小板(×109/L) | 180.0 (153.0-208.0) | 149.0 (127.0-175.0) | 128.0 (109.0-157.0) | 100.0 (91.0-124.0) | 416.7 | 0.000 |
丙氨酸转氨酶(U/L) | 77.0 (41.0-160.0) | 90.0 (39.0-192.0) | 101.0 (46.0-214.0) | 79.0 (44.0-158.0) | 13.8 | 0.000 |
天冬氨酸转氨酶(U/L) | 44.0 (28.0-80.0) | 51.0 (30.0-109.0) | 66.0 (36.0-124.0) | 61.0 (37.0-127.0) | 46.6 | 0.000 |
γ-谷氨酰转肽酶(U/L) | 23.0 (15.0-40.0) | 36.0 (23.0-79.0) | 61.0 (33.0-111.0) | 74.0 (42.0-123.0) | 251.9 | 0.000 |
白蛋白(g/L) | 44.7 (41.7-47.0) | 43.0 (40.4-45.8) | 41.6 (37.9-44.7) | 40.0 (36.6-42.9) | 167.8 | 0.000 |
白蛋白/球蛋白 | 1.6 (1.4-1.9) | 1.6 (1.4-1.8) | 1.4 (1.2-1.6) | 1.2 (1.0-1.4) | 231.0 | 0.000 |
总胆红素(μmol/L) | 13.8 (10.9-18.0) | 15.1 (11.5-19.5) | 15.7 (11.9-22.9) | 19.4 (14.8-27.1) | 85.9 | 0.000 |
凝血酶原国际标准化比值 | 1.0 (0.9-1.0) | 1.0 (1.0-1.0) | 1.0 (1.0-1.1) | 1.1 (1.0-1.2) | 228.5 | 0.000 |
脾脏长度(cm) | 9.7 (8.9-10.4) | 10.1 (9.1-11.0) | 10.7 (9.7-11.6) | 11.3 (10.2-12.6) | 172.3 | 0.000 |
脾脏面积(cm2) | 21.3 (18.1-25.0) | 23.6 (18.7-28.3) | 26.4 (21.3-31.0) | 30.3 (24.4-37.3) | 201.9 | 0.000 |
表3 各模型指数与炎症分级(G)肝纤维化分期(F)的相关性
无创模型 | 相关系数(G) | P值 | 相关系数(F) | P值 |
AAR | 0.139 | <0.01 | 0.215 | <0.01 |
APRI | 0.444 | <0.01 | 0.382 | <0.01 |
API | 0.511 | <0.01 | 0.629 | <0.01 |
CDS | 0.404 | <0.01 | 0.449 | <0.01 |
FIB4 | 0.572 | <0.01 | 0.612 | <0.01 |
GPR | 0.611 | <0.01 | 0.618 | <0.01 |
S | 0.627 | <0.01 | 0.654 | <0.01 |
SPRI | 0.557 | <0.01 | 0.658 | <0.01 |
ASPRI | 0.590 | <0.01 | 0.707 | <0.01 |
FV | 0.699 | <0.01 | 0.775 | <0.01 |
表4 各模型诊断纤维化和早期肝硬化的AUROC
模型 | 肝纤维化(F2-3) | 95%置信区间 | P值 | 早期肝硬化(F4) | 95%置信区间 | P值 |
AAR | 0.539 | 0.501-0.579 | 0.070 | 0.668 | 0.626-0.710 | 0.000 |
APRI | 0.648 | 0.611-0.685 | 0.000 | 0.694 | 0.656-0.732 | 0.000 |
API | 0.765a | 0.732-0.796 | 0.000 | 0.849abc | 0.824-0.875 | 0.000 |
CDS | 0.660 | 0.623-0.697 | 0.000 | 0.740 | 0.702-0.779 | 0.000 |
FIB4 | 0.747ab | 0.714-0.780 | 0.000 | 0.834abc | 0.806-0.863 | 0.000 |
GPR | 0.771a | 0.739-0.802 | 0.000 | 0.825abc | 0.796-0.854 | 0.000 |
S | 0.782a | 0.751-0.813 | 0.000 | 0.839abc | 0.811-0.866 | 0.000 |
SPRI | 0.765a | 0.732-0.797 | 0.000 | 0.891a | 0.866-0.915 | 0.000 |
ASPRI | 0.796 | 0.766-0.826 | 0.000 | 0.912 | 0.892-0.933 | 0.000 |
FV | 0.834 | 0.806-0.861 | 0.000 | 0.928 | 0.911-0.944 | 0.000 |
表5 各模型用于评价肝纤维化(F2-3)的指标
模型 | 界值 | 灵敏度(%) | 特异度(%) | 阳性预测值(%) | 阴性预测值(%) | 准确率(%) | 阳性似然比 | 阴性似燃比 |
AAR | 0.738 | 33.6 | 77.2 | 51.6 | 54.1 | 53.3 | 1.476 | 0.859 |
APRI | 0.822 | 61.1 | 63.7 | 60.5 | 64.3 | 62.5 | 1.682 | 0.611 |
API | 4.5 | 58.6 | 80.2 | 72.9 | 68.0 | 69.9 | 2.963 | 0.516 |
CDS | 6.50 | 42.2 | 82.5 | 68.7 | 61.1 | 63.3 | 2.414 | 0.701 |
FIB4 | 1.245 | 65.9 | 72.6 | 68.7 | 70.1 | 69.4 | 2.409 | 0.469 |
GPR | 0.321 | 74.0 | 67.1 | 67.2 | 71.8 | 70.5 | 2.251 | 0.385 |
S | 0.121 | 66.9 | 76.8 | 72.4 | 71.8 | 72.1 | 2.882 | 0.431 |
SPRI | 6.015 | 75.5 | 67.1 | 67.6 | 75.1 | 71.1 | 2.297 | 0.365 |
ASPRI | 7.395 | 70.2 | 76.1 | 72.8 | 73.7 | 73.3 | 2.936 | 0.392 |
FV | 0.480 | 78.8 | 74.0 | 73.4 | 79.3 | 76.3 | 3.033 | 0.286 |
表6 各模型用于评价早期肝硬化(F4)的指标
模型 | 界值 | 灵敏度(%) | 特异度(%) | 阳性预测值(%) | 阴性预测值(%) | 准确率(%) | 阳性似然比 | 阴性似燃比 |
AAR | 0.748 | 61.3 | 68.4 | 31.7 | 88.1 | 66.9 | 1.937 | 0.566 |
APRI | 0.844 | 77.4 | 53.4 | 28.5 | 90.8 | 58.1 | 1.662 | 0.423 |
API | 5.50 | 76.9 | 78.7 | 46.4 | 93.4 | 78.3 | 3.609 | 0.294 |
CDS | 6.50 | 69.3 | 70.9 | 36.3 | 90.6 | 70.6 | 2.381 | 0.432 |
FIB4 | 1.585 | 84.4 | 68.1 | 38.8 | 94.8 | 71.3 | 2.647 | 0.229 |
GPR | 0.568 | 83.4 | 68.9 | 39.1 | 94.5 | 71.7 | 2.687 | 0.240 |
S | 0.218 | 80.4 | 75.0 | 43.4 | 94.1 | 75.9 | 3.212 | 0.261 |
SPRI | 7.695 | 87.9 | 76.2 | 46.9 | 96.3 | 78.4 | 3.691 | 0.158 |
ASPRI | 9.135 | 89.4 | 77.3 | 48.5 | 96.5 | 79.7 | 3.932 | 0.137 |
FV | 0.644 | 85.4 | 85.0 | 57.7 | 96.2 | 85.1 | 5.679 | 0.172 |
表7 模型FV和年龄-脾脏/血小板比值指数与肝硬度值(Kpa)的ROC曲线下面积
模型 | 肝纤维化(F2-3) | 95%置信区间 | P值 | 早期肝硬化(F4) | 95%置信区间 | P值 |
FV | 0.810(0.039) | 0.733-0.886 | 0.000 | 0.885(0.036) | 0.815-0.955 | 0.000 |
ASPRI | 0.780(0.041) | 0.699-0.860 | 0.000 | 0.889(0.036) | 0.818-0.959 | 0.000 |
肝硬度值 | 0.749(0.043) | 0.664-0.834 | 0.000 | 0.895(0.027) | 0.842-0.949 | 0.000 |
引文著录: 杨晴, 王岩, 关欣, 谷野, 李鲁平, 戴文颖, 卞丽, 尚宁. 无创模型在慢性乙型肝炎肝纤维化诊断中的价值. 世界华人消化杂志 2020; 28(22): 1137-1144