天冬氨酸转氨酶与血小板比值在转氨酶两倍以下慢性乙型肝炎病毒感染患者中的临床应用评价

发布时间：2018-03-29 02:32

  本文选题：APRI　切入点：肝纤维化　出处：《安徽医科大学》2014年硕士论文

【摘要】：目的： 评价血清天冬氨酸转氨酶（AST）与血小板（PTL）比值（APRI），在判断丙氨酸氨基转移酶及天冬氨酸转氨酶（AST及ALT）均在正常检测范围上限（40U/L）2倍以下的慢性乙型肝炎病毒（HBV）感染患者肝脏纤维化程度中的作用,发现潜在抗病毒对象并指导临床抗病毒治疗。 方法: 选择2010-2011年在安徽医科大学第一附属医院感染病科住院行肝组织病理学检查的349例临床诊断慢性HBV感染患者，且肝脏穿刺检查前一周内行肝功能检查，丙氨酸氨基转移酶、天冬氨酸转氨酶均小于2倍正常检测范围上限值（即小于80U/L）。完善常规实验室检查，如血常规、乙肝五项定量（雅培）、乙肝病毒定量检测等和肝脏活组织检查,计算出APRI，比较不同的肝脏纤维化程度与APRI指数的关系。应用受试者工作特征（ROC）曲线评价APRI模型在评估肝脏纤维化程度中的临床诊断及应用价值，采用Spearman等级相关分析判断APRI与肝脏纤维化病理分期的相关性。 研究结果： 1.符合标准的慢性乙性肝炎病毒感者349例，， HBV DNA阳性297例,占85.1%，血清HBeAg阳性196例，占56.2%。根据肝纤维化分期：S0期21例，S1期123例，S2期96例，S3期58例，S4期51例。以S2以上为显著肝纤维化。当APRI≥0.273时，患者有显著肝纤维化，ROC曲线下面积为0.641,灵敏度为48.3%，特异度为75.7%，阳性预测值为73.9%(P=0.0001)；APRI≥0.311时，患者为肝硬化，ROC曲线下面积为0.771,灵敏度为68.6%,特异度为76.8%,阴性预测值为93.5%(P=0.0001)。 2.在HBV DNA为1×103~1×105拷贝/mL组中，APRI≥0.179为明显肝纤维化最优截点，APRI≥0.283为肝硬化最优截点；在HBV DNA为1×106~1×108拷贝/mL组中，APRI≥0.275为明显肝纤维化最优截点，APRI≥0.326为肝硬化最优截点。 3． HBeAg阳性的慢性乙型肝炎病毒感染的病例中，APRI≥0.283为明显肝纤维化最优截点，APRI≥0.287为肝硬化最优截点； HBeAg阴性的慢性乙性肝炎病毒感染的病例中，APRI≥0.179为明显肝纤维化最优截点，APRI≥0.349为肝硬化最优截点， 4．在297例HBV DNA阳性病例中，APRI≥0.273为明显肝纤维化最优截点，APRI≥0.311为肝硬化最优截点；在52例HBV DNA阴性病例中，APRI≥0.153为明显肝纤维化最优截点，APRI≥0.258为肝硬化最优截点。 5.Spearman相关分析显示， APRI与肝纤维化分期呈显著正相关性（r=0.370,P0.001）。 结论： APRI可用于丙氨酸氨基转移酶及天冬氨酸转氨酶均在正常值上限2倍以下的慢性HBV感染患者肝纤维化程度的判断,APRI≥0.273时为有明显肝纤维化(纤维化病理分级在S2及以上),73.9%符合病理分级，对临床选择抗病毒治疗的时机具有一定指导意义。若APRI指数不超过0.311，则93.5%的转氨酶正常值上限2倍以下的慢性乙性肝炎病毒感染者可排除已进展为肝炎肝硬化。根据HBV-DNA水平不同,制定相应的APRI指数评价肝纤维化程度,可提高临床应用价值。
[Abstract]:Objective:. To evaluate the ratio of serum aspartate aminotransferase (AST) to platelets (PTL) and to determine whether alanine aminotransferase, aspartate aminotransferase (AST) and alt are in the upper limit of the normal detection range of chronic hepatitis B virus hepatitis B virus (HBV) infection which is less than 40 U / L ~ (2) times. The role of liver fibrosis, Identify potential antiviral objects and guide clinical antiviral therapy. Methods:. A total of 349 patients with chronic HBV infection were enrolled in the Department of Infectious Diseases, first affiliated Hospital of Anhui Medical University from 2010 to 2011. Liver function examination and alanine aminotransferase were performed within one week before liver puncture examination. Aspartate aminotransferase is less than 2 times the upper limit of normal detection range (that is, less than 80 U / L). Perfect routine laboratory examination, such as blood routine, hepatitis B five quantitative (Abbott, hepatitis B virus quantitative detection and liver biopsy, etc.). The relationship between the degree of hepatic fibrosis and the APRI index was compared. The clinical diagnosis and application value of APRI model in evaluating the degree of hepatic fibrosis were evaluated by using the operating characteristics of the subjects. Spearman grade correlation analysis was used to determine the correlation between APRI and pathological stage of liver fibrosis. Results of the study:. 1. In 349 cases of chronic hepatitis B virus, 297 cases (85.1%) were positive for HBV DNA, and 196 cases were positive for serum HBeAg. According to the stage of hepatic fibrosis, there were 21 cases of stage S 1, 123 cases of S 2 stage, 96 cases of S 3 stage and 58 cases of S 4 stage 51 cases. The liver fibrosis was more than S2. When APRI 鈮

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