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目的构建丙氨酸氨基转移酶(ALT)<2倍正常值上限(ULN)慢性乙型肝炎(乙肝)肝纤维化评分模型。方法选择249例ALT<2倍ULN的慢性乙型病毒性肝炎患者,根据临床经验及相关文献筛选出临床常规指标,经Spearman等级相关逐一分析各指标与肝纤维化之间的关联性,筛选其中6项指标(P<0.05,r>0.259),建立评分模型DMFibroS。通过计算各指标的相对比值,得出分值并累加,使用受试者工作特征曲线(ROC)评价其诊断能力并进行验证。结果纳入患者249例,其中建模组204例,验证组45例。分析6项指标(包括年龄、血小板计数、透明质酸、γ-谷氨酰转肽酶、HBV DNA、脾厚)诊断肝纤维化的受试者工作特征曲线下面积(AUC)波动在0.660~0.777。综合6项指标建立DMFibroS模型,拟将各指标诊断肝纤维化相对比值分别设定为1.0分、1.1分、1.5分,经计算AUC为0.835,6项指标总计6.7分为肝纤维化≥S2的最佳诊断点,此时敏感度为71.2%,特异度为82.8%。以45例患者进行验证,准确度为77.8%。结论 DMFibroS能准确判断ALT<2倍ULN慢性乙肝肝纤维化程度,具有较高的敏感度及准确度,可在一定程度上替代此类患者行肝组织活检。
Objective To construct a liver fibrosis score model of chronic hepatitis B (hepatitis B) with alanine aminotransferase (ALT) <2 times the upper limit of normal (ULN). Methods A total of 249 patients with chronic hepatitis B with ALT <2 times ULN were enrolled. According to the clinical experience and relevant literatures, routine clinical indexes were screened, and the correlation between each index and liver fibrosis was analyzed by Spearman rank correlation 6 indicators (P <0.05, r> 0.259) to establish scoring model DMFibroS. By calculating the relative ratio of each index, the scores were obtained and summed up, and the diagnostic capability of the patients was evaluated and verified by using the receiver operating characteristic curve (ROC). The results included 249 patients, including 204 in the modeling group and 45 in the validation group. The area under the operating characteristic curve (AUC) of 6 indicators (including age, platelet count, hyaluronic acid, γ-glutamyl transpeptidase, HBV DNA and spleen thickness) in diagnosing liver fibrosis fluctuated between 0.660 ~ 0.777. The DMFibroS model was established based on 6 indexes and the relative ratio of diagnosis of liver fibrosis was set to 1.0, 1.1 and 1.5 respectively. The calculated AUC was 0.835. A total of 6.7 indicators of 6 items were liver fibrosis≥S2 The best diagnostic point, the sensitivity was 71.2%, the specificity was 82.8%. Forty-five patients were verified with an accuracy of 77.8%. Conclusion DMFibroS can accurately determine the degree of ALT <2 times ULN chronic hepatitis B liver fibrosis, with high sensitivity and accuracy, to a certain extent, alternative to such patients liver biopsy.