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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

23卷

期数:

2017年05期

页码:

415-418

栏目:

临床医学

出版日期:

2017-09-20

文章信息/Info

Title:

Assessment of non-invasive fibrosis indexes with alpha-fetoprotein?for? hepatitis B virus-related hepatocellular carcinoma

文章编号:

1006-8147(2017)05-0415-04

作者:

周冷潇¹; 2; 韩 涛¹; 2; 刘 芳¹; 2

(1.天津医科大学三中心临床学院肝内科,天津 300170; 2. 天津市第三中心医院肝内科,天津 300170)

Author(s):

ZHOU Leng-xiao¹; 2;  HAN Tao¹; 2;  LIU Fang¹; 2

(1.Department of Hepatology, The Third Central Clinical College ， Tianjin Medical University, Tianjin 300170, China; 2. Department of Hepatology, The Third Central Hospital of Tianjin, Tianjin 300170, China)

关键词:

肝纤维化指标; 肝炎; 乙型; 肝硬化; 肝细胞癌

Keywords:

fibrosis index;  hepatitis B;  liver cirrhosis;  hepatocellular carcinoma

分类号:

R575

DOI:

-

文献标志码:

A

摘要:

目的： 探讨无创肝纤维化指标结合甲胎蛋白（AFP）对乙肝相关肝细胞癌（HCC）的评估价值。方法： 收集慢性乙型肝炎患者423例，包括218例乙肝肝硬化患者（肝硬化组）和205例乙肝相关HCC患者（HCC组）。收集患者年龄的临床资料，检测患者外周血血小板（PLT）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、AFP，并计算AST/ PLT比值指数（APRI）、AST/ALT比值（AAR）、基于4因子的肝纤维化指标（FIB-4）、年龄/PLT计数指数（AP指数）。相关性分析采用Spearman相关分析，用灵敏度判断上述指标对乙肝相关HCC的评估价值。结果： 对所有患者而言，肝硬化组APRI、AAR、FIB-4、AP指数及AFP指标水平显著低于HCC组（P<0.05）。如按照年龄段分层，年龄<50岁患者中肝硬化组FIB-4及AFP指标水平较HCC组显著偏低（P<0.05）；50~59岁患者中肝硬化组APRI、FIB-4、AP指数及AFP指标水平显著低于HCC组（P<0.05）；年龄≥60岁患者中FIB-4、AP指数及AFP指标水平较HCC组显著偏低（P<0.05）；各个年龄段两组其余指标水平相比没有显著差异（P>0.05）。对所有患者，AFP、AFP结合APRI、AFP结合FIB-4、AFP结合AP指数预测乙肝相关HCC的灵敏度分别为76.19%、84.52%、83.93%、91.07%；年龄<50岁者，AFP、AFP结合FIB-4指标预测的灵敏度分别为90.63%、93.75%；50~59岁者，AFP、AFP结合APRI、AFP结合FIB-4预测的灵敏度分别为70.51%、84.26%、83.33%；年龄≥60岁者，AFP、AFP结合FIB-4、AFP结合AP指标预测的灵敏度分别为72.41%、79.31%、94.83%。结论： 虽然不同年龄段存在一定差异，但总体上AFP结合APRI、AFP结合FIB-4及AFP结合AP指数与乙肝相关HCC密切相关，对乙肝相关HCC预测的灵敏度优于单独使用AFP。

Abstract:

Objective: To investigate the non-invasive fibrosis indexes with alpha-fetoprotein (AFP) in patients with Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Methods: A total of 423 patients with chronic hepatitis B were enrolled and divided into two groups: 218 patients with HBV-related cirrhosis as the cirrhosis group and 205 patients with HBV-related HCC as the HCC group. Age, platelet (PLT), alanine aminotransferase (ALT), aspatate aminotransferase (AST) and AFP were tested and AST to PLT ratio index (APRI), aspartate-alanine aminotrasferase ratio (AAR), fibrosis index based on the 4 factor (FIB-4) and Age/PLT index (AP Index) were calculated. Spearman correlation was used to evaluate the associations between HBV-related HCC and these indexes. The sensitivities were calculated to assess the performance of these indexes in predicting HBV-related HCC. Results: APRI, AAR, FIB-4, AP Index and AFP of the cirrhosis group were significantly lower than HCC group for all patients (P<0.05). The HCC group had significantly higher FIB-4 and AFP than the cirrhosis group younger than 50 higher APRI, FIB-4, AP Index and AFP aging from 50 to 59, and higher FIB-4, AP Index and AFP greater than or equal to 60 than cirrhosis group (P<0.05), while others had no statistical significant differences between two groups (P>0.05). The sensitivities of AFP, AFP with APRI, AFP with FIB-4, AFP with AP Index of all ages were 76.19%, 84.52%, 83.93% and 91.07% respectively. The sensitivities of AFP and AFP with FIB-4 less than 50, AFP, AFP with APRI and AFP with FIB-4 from 50 to 59, and AFP, AFP with FIB-4 and AFP with AP Index 60 years or older were 90.63%, 93.75%, 70.51%, 84.26%,83.33%, 72.41%, 79.31% and 94.83% respectively, Conclusion: Although there are differences between different ages, generally AFP with APRI, AFP with AAR, AFP with FIB-4 and AFP with AP Index are closely correlated with HBV-related HCC and all of them may be superior to AFP in sensitivity of HBV-related HCC.

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相似文献/References:

[1]李树倩,周 璐,张 洁,等.96例自身免疫性肝炎患者的临床特征[J].天津医科大学学报,2015,21(03):239.
　LI Shu-qian,ZHOU Lu,ZHANG Jie,et al.Clinical characteristics of 96 patients with autoimmune hepatitis[J].Journal of Tianjin Medical University,2015,21(05):239.

备注/Memo

备注/Memo:

基金项目  国家科技重大专项基金资助（2016ZX10002008-07）；天津市科技计划项目（13RCGFSY19200）

作者简介  周冷潇（1991-），女，硕士在读，研究方向：主要从事肝脏相关疾病研究；通信作者 ：韩涛 ， E-mail:hantaomd@126.com。

常用功能

更新日期/Last Update: 2017-09-20