非创伤性评估乙肝患者肝组织炎症的临床分析-clinical analysis of non-invasive evaluation of hepatitis b patients with liver inflammation.docxVIP

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非创伤性评估乙肝患者肝组织炎症的临床分析-clinical analysis of non-invasive evaluation of hepatitis b patients with liver inflammation.docx

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非创伤性评估乙肝患者肝组织炎症的临床分析-clinical analysis of non-invasive evaluation of hepatitis b patients with liver inflammation

上海交通大学医学院硕士学位论文上海交通大学医学院硕士学位论文 - - IV - receiver operating characteristic curves (ROC). The diagnostic values were assessed by measuring the areas under receiver operating characteristic curve(AUROC), estimating sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and diagnostic accuracy（DA）. Results: Multivariate analysis identified alanine aminotransferase (ALT),aspartate aminotransferase(AST), γ-glutamyltransferase(GGT)， platelets (PLT) and albumin (Alb) as the best predictors of liver necro- inflammatory. A diagnostic model was constructed: G score=3.535+0.001× lnALT+0.002×lnAST+0.007×lnGGT-0.067×lnALB-0.011×lnPLT. The area under the receiver operating characteristic curve (AUROC) was 0.728 for the training group and 0.706 for the validation group.Using a cutoff score of 3.26, the presence of significant necro-inflammatory (Knodell 4-18)could be excluded with high accuracy (95.16% sensitivity, 81.25% negative predictive value [NPV],and 59.60% positive predictive value [PPV]) in the training group, and with the same certainty (93.48% sensitivity, 72.73% NPV, and 65.65% PPV) in the validation group. Similarly, applying a cutoff score of ≥3.28, the presence of significant necro-inflammatory could be correctly identified with high accuracy (92.45% specificity , 88.57% PPV ,and 61.25% NPV) in the training group, and with the same certainty (86.89% specificity, 78.95% PPV,and 46.09% NPV) in the - - PAGE VIII - validation group. Conclusions: A predictive model (G score) with a combination of routine variables identified CHB patients with and without significant necro-inflammatory with a high degree of accuracy. Application of this model may potentially decrease the need for liver biopsy among patients with CHB.So it can provide convenience for chinical work. KEY WORDS ： chronic hepatitis B, noninvasive ， assessment, necro-inflammatory 插图和附表清单插图清单图 1. 建模组病例炎症分级构成比 9 图 2. G 值与炎症分级的箱图 15 图 3. 建模组诊断模型的 ROC 曲线 16 图 4.