Wang B, Li Y, Xiao L, Xu H T, Xian J C
Department of Hepatology, the Affiliated Taizhou People's Hospital of Nanjing Medical University ( Taizhou People's Hospital ), Taizhou 225300, China.
Zhonghua Gan Zang Bing Za Zhi. 2023 Aug 20;31(8):862-868. doi: 10.3760/cma.j.cn501113-20230517-00225.
Plateletcrit (PCT) is considered a new potential index to predict the degree of liver fibrosis in patients with chronic hepatitis B (CHB). This study aimed to explore the predictive value of PCT for the degree of liver fibrosis in patients with chronic hepatitis B virus (HBV) infection with alanine aminotransferase (ALT) < 2× upper limit of normal (ULN). Measurement data were compared using the -test, ANOVA, or non-parametric test (Mann-Whitney test). Categorical variables were compared using (2) test or Fisher's exact test. 140 cases with chronic HBV infection who underwent liver biopsy and ALT < 2×ULN were enrolled from January 2016 to March 2021. Univariate and multivariate logistic regression and the area under the receiver operating characteristic curve (AUC) were used to determine the predictive value of PCT for the degree of liver fibrosis. The likelihood ratio (LR) was used to optimize the selection of the diagnostic cut-off. (1) Among the 140 cases, there were 34 (24.3%) cases in the S0 stage, 47 (33.6%) cases in the S1 stage, 16 (11.4%) cases in the S2 stage, 19 (13.6%) cases in the S3 stage, and 24 (17.1%) cases in the S4 stage. The overall mean PCT level was 0.19 ± 0.06%. (2) Univariate analysis revealed that PCT between patients with stages of liver fibrosis was S(0-1) and S(2-4) (0.20% ± 0.05% vs. 0.16% ± 0.06%, = 3.955, < 0.001), S(0 -2) and S(3-4) (0.20% ± 0.05% vs. 0.15% ± 0.06%, = 5.631, < 0.001) and S(0-3) and S4 (0.20% ± 0.05% vs. 0.12% ± 0.05%, = 7.113, < 0.001), respectively, and the differences were statistically significant. Multivariate logistic regression analysis showed that PCT was an independent risk factor for liver fibrosis stages S(2-4), S(3-4), and S4 ( = 0.925, 95% : 0.859 - 0.997, = 0.042; = 0.867, 95% : 0.789 - 0.954, = 0.003; = 0.708, 95% : 0.593 - 0.846; < 0.001). (3) The AUCs of PCT were 0.702, 0.777, and 0.885 for diagnosing liver fibrosis stages S(2-4), S(3-4), and S4 in patients with chronic HBV infection with ALT < 2×ULN. PCT was superior for the cirrhosis (S4) diagnosis. 92 (65.7%) cases were diagnosed as cirrhosis or non-cirrhosis according to the LR optimized diagnostic and exclusion diagnostic cut-offs (≤0.09%, ≤0.17%), with an accuracy of 97.8%. PCT has a high diagnostic and exclusion value for cirrhotic patients with chronic HBV infection with ALT < 2×ULN. Furthermore, it can be used as a non-invasive diagnostic index for determining and assisting the diagnosis of cirrhosis in resource-constrained areas, reducing the need for pathological examination of liver biopsies, and it has the advantage of being simple and intuitive without complex calculations.
血小板压积（PCT）被认为是预测慢性乙型肝炎（CHB）患者肝纤维化程度的一个新的潜在指标。本研究旨在探讨PCT对丙氨酸氨基转移酶（ALT）<2倍正常上限（ULN）的慢性乙型肝炎病毒（HBV）感染患者肝纤维化程度的预测价值。计量资料采用t检验、方差分析或非参数检验（曼-惠特尼U检验）进行比较。分类变量采用χ²检验或Fisher精确检验进行比较。选取2016年1月至2021年3月期间140例接受肝活检且ALT<2倍ULN的慢性HBV感染患者。采用单因素和多因素逻辑回归以及受试者操作特征曲线下面积（AUC）来确定PCT对肝纤维化程度的预测价值。采用似然比（LR）来优化诊断界值的选择。（1）140例患者中，S0期34例（24.3%），S1期47例（33.6%），S2期16例（11.4%），S3期19例（13.6%），S4期24例（17.1%）。PCT总体平均水平为0.19±0.06%。（2）单因素分析显示，肝纤维化S（0-1）期与S（2-4）期患者的PCT（0.20%±0.05% vs. 0.16%±0.06%，t=3.955，P<0.001）、S（0-2）期与S（3-4）期患者的PCT（0.20%±0.05% vs. 0.15%±0.06%，t=5.631，P<0.001）以及S（0-3）期与S4期患者的PCT（0.20%±0.05% vs. 0.12%±0.05%，t=7.113，P<0.001）差异均有统计学意义。多因素逻辑回归分析显示，PCT是肝纤维化S（2-4）期、S（3-4）期和S4期的独立危险因素（β=0.925，95%CI：0.859-0.997，P=0.042；β=0.867，95%CI：
