γ-谷氨酰转肽酶与胆碱酯酶和血小板比值在预测慢性乙型肝

StephenW

Clin Microbiol Infect. 2018 Jun 12. pii: S1198-743X(18)30461-0. doi: 10.1016/j.cmi.2018.06.002. [Epub ahead of print]
Gamma-glutamyl transpeptidase to cholinesterase and platelet ratio in predicting significant liver fibrosis and cirrhosis of chronic hepatitis B.
Liu D1, Li J2, Lu W1, Wang Y1, Zhou X1, Huang D1, Li X1, Ding R1, Zhang Z3.
Author information

1
    Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
2
    Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China; Department of Infectology, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.
3
    Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China; Department of Infectology, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China. Electronic address: [email protected].

Abstract
OBJECTIVE:

To evaluate the performance of a new mathematical model gamma- glutamyl transpeptidase to cholinesterase and platelet ratio (GCPR) versus gamma- glutamyl transpeptidase to platelet ratio (GPR) in predicting significant fibrosis and cirrhosis of chronic hepatitis B (CHB).
METHODS:

A complete cohort of 2343 patients was divided into early and late cohort depending on the time of liver biopsy. With reference to the Scheuer standard, liver pathological stage ≥S2 and ≥S4 were defined as significant fibrosis and cirrhosis, respectively. ROC curve was used to evaluate the performance of investigated models.
RESULTS:

In early cohort，the areas under ROC curves (AUROCs) of GCPR in predicting significant fibrosis of HBeAg-positive and HBeAg-negative patients (0.782 and 0.775) were both significantly greater than those of GPR (0.748 and 0.747) (Z＝8.198 and Z＝6.023, both P<0.0001); the AUROCs of GCPR in predicting cirrhosis of HBeAg-positive and HBeAg-negative patients (0.842 and 0.861) were both significantly greater than those of GPR (0.802 and 0.823) (Z＝6.686 and Z＝6.116, both P<0.0001). In early, late and complete cohort, using a single cutoff of GPCR>0.080, the specificities of GCPR in predicting significant fibrosis of HBeAg-positive patients were 83.3%, 88.2% and 85.0%, and of HBeAg-negative patients were 87.6%, 87.4% and 87.6%, respectively; and the sensitivities of GCPR in predicting cirrhosis of HBeAg-positive patients were 81.9%, 88.7% and 84.2%, and of HBeAg-negative patients were 83.1%,82.1% and 82.7%, respectively.
CONCLUSIONS:

GCPR has higher performance than GPR in predicting significant fibrosis and cirrhosis of CHB.

Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

PMID:
    29906588
DOI:
    10.1016/j.cmi.2018.06.002

StephenW

临床微生物感染。 2018年6月12日。pii：S1198-743X（18）30461-0。 doi：10.1016 / j.cmi.2018.06.002。 [电子版提前打印]
γ-谷氨酰转肽酶与胆碱酯酶和血小板比值在预测慢性乙型肝炎肝纤维化和肝硬化中的意义
Liu D1，Li J2，Lu W1，Wang Y1，Zhou X1，Huang D1，Li X1，Ding R1，Zhang Z3。
作者信息

1
    复旦大学上海市公共卫生临床中心肝胆内科，上海201508
2
    上海市公共卫生临床中心肝胆医学科，上海201508;温州医科大学附属第一医院感染科，温州325000
3
    上海市公共卫生临床中心肝胆医学科，上海201508;温州医科大学附属第一医院感染科，温州325000电子地址：[email protected]。

抽象
目的：

评估新的数学模型γ-谷氨酰转肽酶对胆碱酯酶和血小板比率（GCPR）与γ-谷氨酰转肽酶与血小板比率（GPR）预测慢性乙型肝炎（CHB）显着纤维化和肝硬化的性能。
方法：

根据肝活检的时间将2343名患者的一个完整队列分为早期和晚期队列。参考Scheuer标准，肝脏病理分期≥S2和≥S4分别定义为显着纤维化和肝硬化。 ROC曲线用于评估研究模型的性能。
结果：

在早期队列中，GCPR的ROC曲线下面积（AUROCs）预测HBeAg阳性和HBeAg阴性患者（0.782和0.775）的显着纤维化均显着高于GPR（0.748和0.747）（Z = 8.198和Z = 6.023，均P <0.0001）; GCPR的AUROCs预测HBeAg阳性和HBeAg阴性患者的肝硬化（0.842和0.861）均显着高于GPR（0.802和0.823）（Z = 6.686和Z = 6.116，均P <0.0001）。 GCPR在预测HBeAg阳性患者显着纤维化中的特异性分别为83.3％，88.2％和85.0％，而HBeAg阴性患者的特异性分别为87.6％分别为87.4％和87.6％; GCPR预测HBeAg阳性患者肝硬化的敏感性分别为81.9％，88.7％和84.2％，HBeAg阴性患者的敏感性分别为83.1％，82.1％和82.7％。
结论：

GCPR在预测CHB显着纤维化和肝硬化方面的表现优于GPR。

版权所有©2018年欧洲临床微生物学和传染病学会。由Elsevier Ltd.出版。保留所有权利。

结论：
    29906588
DOI：
    10.1016 / j.cmi.2018.06.002

桦子

请教   StephenW：
GPR的公式: r 谷氨酰转肽酶/血小板
GCPR 的公式：r谷氨酰转肽酶×胆碱酯酶/血小板
上面公式是否正确？纤维化和硬化的标准分别是多少？谢谢？

StephenW

回复 桦子 的帖子

GPR的公式 = (GGT (U/L)/ULN of GGT)/PLT count (10**9/ L) ×100

GPR的截止点(cut-off)和准确性仍在讨论中. 请阅读:
Reassessment of gamma-glutamyl transpeptidase to platelet ratio (GPR): a large-sample, dynamic study based on liver biopsy in a Chinese population with chronic hepatitis B virus (HBV) infection
重新评估γ-谷氨酰转肽酶与血小板比值（GPR）：一项基于肝活检的大样本动态研究，在中国人群中慢性乙型肝炎病毒（HBV）感染
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890646/
"In conclusion, the accuracy of GPR to diagnose significant fibrosis (F2–4) and extensive fibrosis (F3–4) was comparable to that of APRI, while its accuracy to diagnose cirrhosis (F4) was better. However, its accuracy to diagnose all stages of liver fibrosis was worse compared with FIB-4. In addition, the responsiveness of GPR was greater than that of APRI and FIB-4 during treatment of NAs. Thus, we believe that GPR should be considered as a suitable, simple, non-invasive marker for the diagnosis of liver fibrosis and the dynamic assessment of treatment response in Chinese patients with chronic HBV infection."
"总之，GPR诊断显着纤维化（F2-4）和广泛纤维化（F3-4）的准确性与APRI相当，而诊断肝硬化（F4）的准确性更好。 然而，与FIB-4相比，其诊断肝纤维化各阶段的准确性更差。 此外，GPR治疗期间GPR的反应性高于APRI和FIB-4。 因此，我们认为GPR应该被认为是一种合适的，简单的，非侵入性的肝纤维化诊断标志物和中国慢性HBV感染患者治疗反应的动态评估。"

GCPR仍然试图找出更多的信息.

tacolynn

回复 桦子 的帖子

在网上找了一个，不知道是不是这个。

血清胆碱酯酶/r谷氨酰转肽酶的比值在肝硬化患者中的变化。

健康对照组的平均值是349.8，肝硬化组的平均值是50.9.  也就是这个比值越高越好。其中肝硬化组还分为ABC三级，这个比值逐级降低。

tacolynn

好像我楼上说的这个不是楼主贴的文章里说的，不过这个也有借鉴意义。

我看了看我老公从发病到现在这个公式的比值：2015年5月发病这个值是104,  2018年3月检查这个值是298.  三年期间这个值是曲线上升的。

桦子

tacolynn 发表于 2018-6-25 20:01
好像我楼上说的这个不是楼主贴的文章里说的，不过这个也有借鉴意义。

我看了看我老公从发病到现在这个公式 ...

谢谢！看了这篇论文，有参考价值。