天冬氨酸转氨酶/胆碱酯酶比值预测慢性乙型肝炎肝纤维化程度的性能评价

目的 评价天冬氨酸转氨酶/胆碱酯酶比值（ACR）和天冬氨酸转氨酶/血小板比值（APR）预测慢性乙型肝炎（CHB）肝纤维化程度的性能。方法 1335例HBeAg阳性和1026例HBeAg阴性CHB患者入选本研究。肝脏病理学诊断采用Scheuer评分系统，病理学分期≥S2和≥S4分别定义为显著肝纤维化和肝硬化。ACR和APR预测肝纤维化程度的实用截断值从其预测显著肝纤维化的特异度与预测肝硬化的灵敏度的重叠区间内优选。结果 HBeAg阳性患者，ACR和APR预测显著肝纤维化ROC曲线下面积（AUROCs）分别为0.772和0.765，预测肝硬化的AUROCs分别为0.751和0.756；以实用截断值ACR>0.200和APR>1.000为标准，其预测显著肝纤维化灵敏度、特异度分别为60.4%、79.2%和56.8%、78.8%，预测肝硬化的灵敏度、特异度分别为77.3%、61.2%和76.2%、63.8%。HBeAg阴性患者，ACR和APR预测显著肝纤维化AUROCs分别为0.756和0.741，预测肝硬化的AUROCs分别为0.805和0.786；以实用截断值ACR>0.125和APR>0.750为标准，其预测显著肝纤维化灵敏度、特异度分别为59.0%、80.4%和58.1%、79.8%，预测肝硬化的灵敏度、特异度分别为80.7%、68.3%和80.2%、68.5%。结论 ACR和APR预测HBeAg阳性与阴性患者显著肝纤维化和肝硬化的实用截断值不能一致；无论HBeAg阳性或阴性患者，ACR与APR预测显著肝纤维化和肝硬化的灵敏度、特异度高度一致。
Objective To evaluate the application of aspartate aminotransferase to cholinesterase ratio(ACR) versus aspartate aminotransferase to platelet ratio(APR) in predicting the severity of hepatic fibrosis in patients with chronic hepatitis B(CHB). Methods Total 1335 HBeAg positive and 1026 HBeAg negative patients with CHB were enrolled. According to Scheuer score system, pathological stage ≥S2 was defined as significant hepatic fibrosis, and ≥4 was defined as cirrhosis. The ROC curve was used to assess the value of ACR and APR in predicting the hepatic fibrosis and cirrhosis. Results In HBeAg positive patients, the areas under the ROC curves(AUC) of ACR and APR for predicting significant hepatic fibrosis were 0.772 and 0.765 respectively, and those for predicting cirrhosis were 0.751 and 0.756, respectively；with ACR>0.200 and APR>1.000 as cutoff values, the sensitivity, specificity of ACR and APR for predicting significant hepatic fibrosis were 60.4%, 79.2% and 56.8%, 78.8%, respectively, and those for predicting cirrhosis were 77.3%, 61.2% and 76.2%, 63.8%, respectively. In HBeAg negative patients, the AUC of ACR and APR for predicting significant hepatic fibrosis were 0.756 and 0.741 respectively, and those for predicting cirrhosis were 0.805 and 0.786 respectively; with ACR>0.125 and APR>0.750 as cutoff values, the sensitivity, specificity of ACR and APR for predicting significant hepatic fibrosis were 59.0%, 80.4% and 58.1%, 79.8%, respectively, and those for predicting cirrhosis were 80.7%, 68.3% and 80.2%, 68.5%, respectively. Conclusion The cutoff values of ACR and APR for predicting significant hepatic fibrosis and cirrhosis in HBeAg positive patients are inconsistent with those in HBeAg negative patients; the sensitivity and specificity of ACR for predicting significant hepatic fibrosis and cirrhosis are consistent with those of APR regardless