文章摘要
APRI与原发性胆汁性胆管炎不良预后关系的临床研究
Clinical study on the correlation between APRI and progression to adverse outcomes in primary biliary cholangitis
投稿时间：2019-03-15  修订日期：2019-09-10
DOI：
中文关键词: AST/PLT比值指数  原发性胆汁性胆管炎  预后  临床研究  
英文关键词: AST/platelet ratio index  primary biliary cholangitis  prognosis  clinical study
基金项目:国家自然科学基金资助项目(81370529),国家自然科学青年基金资助项目(81700521)
作者单位邮编
陈刚 安徽医科大学第一附属医院消化内科 230022
李杨 安徽医科大学第一附属医院消化内科 
张卫平 安徽医科大学第一附属医院消化内科 
许建明* 安徽医科大学第一附属医院消化内科 230022
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中文摘要:
      目的 探讨AST/PLT比值指数(APRI)与原发性胆汁性胆管炎（PBC）患者不良预后的关系。 方法 选取2008年1月至2018年05月PBC 123例，其中行肝活组织穿刺检查46例。Spearman秩相关分析APRI与PBC肝组织学分期的关系，重点评估APRI、AST、1/PLT与PBC不良事件的相关性，分别绘制预测终点事件的ROC曲线并确定最佳截断值，对AUC面积最大的指标，进一步LogRank分析PBC无终点事件生存率。 结果 123例PBC患者中，28例出现终点事件，其中肝移植7例，肝病相关死亡21例。Spearman秩相关分析提示APRI与PBC肝组织学分期正相关(秩相关系数Rs=0.55, P＜0.001)。APRI、AST、1/PLT预测PBC终点事件的ROC曲线下面积（AUROC）分别为0.84（0.75-0.93）、0.76 （0.66-0.86）、0.81 (0.71-0.91)，截断值分别为1.33、90.5和0.0076。APRI>1.33、AST>90.5、1/PLT>0.0076判断PBC发生终点事件敏感性和特异性分别为85.71%、75.00%、71.43%和76.84%、81.05%、76.84；阳性和阴性预测值分别为52.17%、53.85%、47.62%和94.81%、91.67%、90.12%，预测的准确性分别为78.86%、79.67%、75.61%。APRI＞1.33组较APRI≤1.33组生存率显著降低，差异有统计学意义(P＜0.0001)。 结论 APRI与PBC肝组织学分期正相关，基线APRI＞1.33对PBC患者进展为肝移植或肝病相关死亡有一定预测价值。
英文摘要:
      Objective To explore the association between AST/platelet ratio index (APRI) and progression to adverse outcomes in primary biliary cholangitis (PBC). Methods From January 2008 to November 2018,123 cases of PBC patients who treated in our hospital were collected and analyzed. among them 46 received liver biopsy. Spearman’s rank correlation coefficient test between baseline APRI with histological stage in PBC. The correlation of APRI, AST, reciprocal of platelet count and PBC adverse events was assessed emphatically, Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off values for predicting endpoint events , respectively. the AUC area was the largest indicator, and the survival rate of PBC without endpoint events was further analyzed by LogRank test. Results Of the 123 patients with PBC, 28 patients with adverse outcomes, among them 7 patients required liver transplantation (LT) whereas a further 21 patients died liver-related death. APRI positively correlated with histological disease progression(rs=0.55, P＜0.001, Spearman’s rank correlation coefficient test). APRI, AST and 1/PLT predicted the area under the ROC curve of the PBC endpoint events (AUROC) was 0.84 ((95% confidence interval (CI) 0.75-0.93), 0.76 ((95% confidence interval (CI) 0.66-0.86) and 0.81 ((95% confidence interval (CI) 0.71-0.91), and the optimal cut-off values were 1.33, 90.5 and 0.0076, respectively. The sensitivity and specificity of PBC were 85.71%, 75.00%, 71.43%, 76.84%, 81.05% and 76.84 respectively.The positive and negative predictive values were 52.17%, 53.85%, 47.62%, 94.81%, 91.67% and 90.12%, respectively. The accuracy of prediction was 78.86%, 79.67% and 75.61%, respectively. APRI > 1.33 group had a significantly lower survival rate than APRI≤1.33group (P < 0.0001). Conclusions APRI positively correlated with histological disease progression in PBC patients, elevated baseline APRI(APRI>1.33) is associated with an increased risk of adverse events in PBC. APRI appears to be a useful tool in the clinical assessment of patients with PBC.
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