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目的:建立一个基于临床、血清学及超声检查等指标的非创伤性肝纤维化诊断模型。方法:慢性肝脏疾病患者271例,随机分成建模组190例和验证组81例,均行肝组织病理学检查,同时检测记录17项临床、血清学及超声检测指标的结果。在建模组对各指标依次行单因素分析和多因素Logistic回归分析,筛选出与研究终点相关的独立危险因素,在此基础上构建非创伤性肝纤维化诊断模型,最后用独立的验证组检验该模型的诊断效率。结果:在单因素分析有统计学意义的10个因素中,筛选出3个独立的危险因素凝血酶原时间的国际标准化比值、碱性磷酸酶和肝中静脉内径,并建立由这3个因素组成的非创伤性肝纤维化诊断模型。S0和S1评分低于S2,S3和S4(P<0.01);非创伤性肝纤维化诊断模型评分与肝纤维化分期呈正相关(γs=0.545,P<0.01);ROC曲线分析显示非创伤性肝纤维化诊断模型诊断显著肝纤维化(S2-4)、严重肝纤维化(S3-4)和肝硬化(S4)的AUC分别为0.757,0.748和0.903,最佳诊断值分别为5.47,6.09和6.97,其诊断准确度分别为75.8%,70%和88.9%。非创伤性肝纤维化诊断模型应用于验模组,其诊断显著肝纤维化、严重肝纤维化和肝硬化的特征曲线下面积分别为0.737,0.721和0.908。结论:应用非创伤性肝纤维化诊断模型评分评估慢性肝脏疾病的肝纤维化程度具有较好的准确度和可重复性,有望在一定程度上替代肝组织病理检查来监测慢性肝脏疾病的肝纤维化的动态变化。
Objective: To establish a noninvasive diagnostic model of liver fibrosis based on clinical, serological and ultrasonographic indexes. Methods: A total of 271 patients with chronic liver disease were randomly divided into model group (n = 190) and validation group (n = 81). All patients underwent liver histopathology. Seventeen clinical, serological and sonographic indexes were also recorded. In the modeling group, univariate analysis and multivariate Logistic regression analysis of each index followed by screening of independent risk factors related to the end of the study. On this basis, a non-invasive diagnosis model of liver fibrosis was constructed. Finally, with independent verification group Test the diagnostic efficiency of the model. RESULTS: Of the 10 factors that were statistically significant in the univariate analysis, three independent risk factors were screened for the international normalized ratio of prothrombin time, alkaline phosphatase, and the diameter of the middle hepatic vein, and were established by these three factors Composed of non-invasive liver fibrosis diagnosis model. The scores of S0 and S1 were lower than those of S2, S3 and S4 (P <0.01). The score of non-invasive liver fibrosis diagnosis model was positively correlated with the stage of liver fibrosis (γs = 0.545, P <0.01); ROC curve analysis showed non-invasive The AUC of diagnosis of liver fibrosis (S2-4), severe liver fibrosis (S3-4) and cirrhosis (S4) were 0.757, 0.748 and 0.903, respectively. The best diagnostic value was 5.47, 6.09 And 6.97, the diagnostic accuracy of 75.8%, 70% and 88.9% respectively. Non-invasive liver fibrosis diagnostic model used in the test group, the diagnosis of significant liver fibrosis, severe liver fibrosis and cirrhosis area under the characteristic curve were 0.737,0.721 and 0.908. Conclusion: The application of non-invasive liver fibrosis diagnosis model score to evaluate the degree of liver fibrosis in patients with chronic liver disease has good accuracy and repeatability, and is expected to replace liver tissue pathology to some extent to monitor the liver fibrosis of chronic liver disease The dynamic changes.