Zhai X W, Liu S H, Yao M J, Qian X J, Wen X J, Xu Q, Zhao J M, Lu F M
Department of Epidemiology and Statistics, College of Public Health Zhengzhou University, Zhengzhou 450001, China.
Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China.
Zhonghua Gan Zang Bing Za Zhi. 2020 Jan 20;28(1):47-52. doi: 10.3760/cma.j.issn.1007-3418.2020.01.012.
To establish and evaluate diagnostic efficacy and applicability of serum Golgi protein (GP) 73 based non-invasive diagnostic model with other conventional serological indicators for compensated stage hepatitis B cirrhosis. 666 cases with chronic hepatitis B (CHB) who had visited to the Fifth Medical Center of People's Liberation Army General Hospital from January 2010 to December 2017 were selected as the study subjects, and were classified according to compensated stage cirrhosis into clinical and pathological diagnosis group based on whether or not the liver histological examination was performed. A diagnostic model of compensated stage hepatitis B cirrhosis in the clinical diagnosis group was established. The current clinically used diagnostic model of liver cirrhosis, aspartate aminotransferase/platelet ratio index (APRI), fibrosis index (FIB)-4 and liver stiffness measurement (LSM) were compared. Eventually, the diagnostic model was verified step by step by pathological diagnosis group. The area under the receiver operating characteristic curve (AUC) of GP73 and APRI, FIB-4, and LSM for cirrhosis patients in the clinical diagnosis group were 0.842, 0.857, 0.864, and 0.832, respectively. The diagnostic efficiency of the four indicators were of similar ( value > 0.05). A diagnostic model of compensated stage hepatitis B cirrhosis (GAPA) using logistic regression analysis was established: LogitP = 1/ [1 + exp (1.614-0.054 × GP73-0.045 × Age + 0.030 × PLT-0.015 × ALP)]. The AUC of the model was as high as 0.940 and the optimal cut-off value were 0.41. The corresponding diagnostic sensitivity and specificity were 0.92 and 0.82, respectively. The diagnostic efficiency was better than that of APRI, FIB-4, LSM and GP73 alone ( < 0.05). The AUC of GAPA was 0.877 in the pathological diagnosis group, which was similar to the diagnostic efficacy of LSM (0.891) and FIB-4 (0.847) ( > 0.1), but still superior to that of APRI (0.811) and GP73 alone (0.780) ( < 0.001). GAPA, a diagnostic model for compensated stage hepatitis B cirrhosis established in this study, has a good diagnostic efficacy in both the clinical and pathological diagnosis group, and has certain auxiliary diagnostic value in the areas where resources are relatively scarce or where LSM has not been developed.
建立并评估基于血清高尔基体蛋白（GP）73的无创诊断模型与其他传统血清学指标对代偿期乙型肝炎肝硬化的诊断效能及适用性。选取2010年1月至2017年12月就诊于解放军总医院第五医学中心的666例慢性乙型肝炎（CHB）患者作为研究对象，根据是否进行肝脏组织学检查，将代偿期肝硬化患者按临床和病理诊断分为两组。在临床诊断组中建立代偿期乙型肝炎肝硬化的诊断模型。比较目前临床使用的肝硬化诊断模型，即天冬氨酸氨基转移酶/血小板比值指数（APRI）、纤维化指数（FIB）-4和肝脏硬度值（LSM）。最终，通过病理诊断组逐步验证该诊断模型。临床诊断组中肝硬化患者的GP73、APRI、FIB-4和LSM的受试者工作特征曲线下面积（AUC）分别为0.842、0.857、0.864和0.832。这四个指标的诊断效能相似（P值>0.05）。采用逻辑回归分析建立了代偿期乙型肝炎肝硬化的诊断模型（GAPA）：LogitP = 1/ [1 + exp (1.614 - 0.054 × GP73 - 0.045 × 年龄 + 0.030 × 血小板计数 - 0.015 × 碱性磷酸酶)]。该模型的AUC高达0.940，最佳截断值为0.41。相应的诊断敏感性和特异性分别为0.92和0.82。其诊断效能优于单独的APRI、FIB-4、LSM和GP73（P<0.05）。病理诊断组中GAPA的AUC为0.877，与LSM（0.891）和FIB-4（0.847）的诊断效能相似（P>0.1），但仍优于APRI（0.811）和单独的GP73（0.780）（P<0.001）。本研究建立的代偿期乙型肝炎肝硬化诊断模型GAPA在临床和病理诊断组中均具有良好的诊断效能，在资源相对匮乏或未开展LSM检查的地区具有一定的辅助诊断价值。
