CAJ | 학술논문

目的：优化已建立的HBV相关性肝细胞癌（HCC）预测模型（REACH‐B评分模型）。方法收集2004年10月1日至2014年5月1日于福建医科大学附属第一医院肝病中心初次入院、HBsAg阳性超过半年的患者，分为 HCC组和对照组（非 HCC组），回顾性收集相关指标，进行评分评估。用受试者工作特征曲线判断各模型预测价值。结果预测3年 HBV相关性 HCC发生，共纳入627例患者，其中HCC组151例，对照组476例。REAC H‐B评分模型预测3年 HCC发生的曲线下面积（AUC）为0．78（95％ CI：0．74～0．82），敏感度为73．00％，特异度为78．70％。联合甲胎蛋白（AFP）建立R‐AFP评分模型，对3年 HCC发生的AUC升至0．80（95％ CI：0．76～0．83，Z＝2．50，P＝0．01），敏感度为71．03％，特异度为79．13％。联合甲胎蛋白异质体3与AFP之比（AFP‐L3％）建立R‐AFP‐L3％评分模型，对3年HCC发生的AUC进一步升至0．83（95％ CI：0．80～0．87，Z＝2．45，P＝0．01），敏感度为75．01％，特异度为79．32％。预测5年 HBV 相关性 HCC 发生，共纳入159例患者，其中HCC组65例，对照组94例。REACH‐B评分模型预测5年 HCC发生的AUC为0．79（95％ CI：0．72～0．87），敏感度为73．60％，特异度为75．43％。R‐AFP评分模型对5年 HCC发生的预测价值 AUC升至0．84（95％ C I：0．77～0．90，Z＝2．70，P＝0．006），敏感度为83．12％，特异度为77．89％。结论联合AFP及AFP‐L3％能优化REACH‐B评分模型对3年和5年HBV相关性HCC发生的预测价值。
목적：우화이건립적HBV상관성간세포암（HCC）예측모형（REACH‐B평분모형）。방법수집2004년10월1일지2014년5월1일우복건의과대학부속제일의원간병중심초차입원、HBsAg양성초과반년적환자，분위 HCC조화대조조（비 HCC조），회고성수집상관지표，진행평분평고。용수시자공작특정곡선판단각모형예측개치。결과예측3년 HBV상관성 HCC발생，공납입627례환자，기중HCC조151례，대조조476례。REAC H‐B평분모형예측3년 HCC발생적곡선하면적（AUC）위0．78（95％ CI：0．74～0．82），민감도위73．00％，특이도위78．70％。연합갑태단백（AFP）건립R‐AFP평분모형，대3년 HCC발생적AUC승지0．80（95％ CI：0．76～0．83，Z＝2．50，P＝0．01），민감도위71．03％，특이도위79．13％。연합갑태단백이질체3여AFP지비（AFP‐L3％）건립R‐AFP‐L3％평분모형，대3년HCC발생적AUC진일보승지0．83（95％ CI：0．80～0．87，Z＝2．45，P＝0．01），민감도위75．01％，특이도위79．32％。예측5년 HBV 상관성 HCC 발생，공납입159례환자，기중HCC조65례，대조조94례。REACH‐B평분모형예측5년 HCC발생적AUC위0．79（95％ CI：0．72～0．87），민감도위73．60％，특이도위75．43％。R‐AFP평분모형대5년 HCC발생적예측개치 AUC승지0．84（95％ C I：0．77～0．90，Z＝2．70，P＝0．006），민감도위83．12％，특이도위77．89％。결론연합AFP급AFP‐L3％능우화REACH‐B평분모형대3년화5년HBV상관성HCC발생적예측개치。
Objective T he present study aimed to optimize the established predictive models (REACH‐B scoring model) for hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) . Methods The hepatitis B surface antigen (HBsAg) positive (> 6 months) patients who were firstly admitted in the Liver Center of First Affiliated Hospital ,Fujian Medical University between Oct 1st 2004 and May 1st 2014 were selected as the subjects and divided into two groups ,namely ,the case group (HCC group) and the control group (non‐HCC group) .Clinical data of all the subjects were retrospectively collected and analyzed .Receiver operating characteristic curves were used to evaluate the predictive values of the various models .Results To predict the development of HBV‐related HCC within 3 years ,a total of 627 patients (151 HCC cases and 476 non‐HCC controls) were enrolled .Area under curve (AUC) of HBV‐related HCC (REACH‐B) scoring model was 0 .78 (95% CI:0 .74-0 .82) ,with the sensitivity of 73 .00% and specificity of 78 .70% in predicting 3‐year risk of HCC occurrence .By combining alpha‐fetoprotein (AFP) and REACH‐B ,the R‐AFP scoring model was constructed .The AUC increased to 0 .80 (95% CI:0 .76 -0 .83 , Z= 2 .50 , P= 0 .01) ,with the sensitivity of 71 .03% and specificity of 79 .13% in predicting 3‐year HCC development .By combining AFP isoform 3 (AFP‐L3% ) and REACH‐B ,the R‐AFP‐L3% scoring model was constructed .The AUC further increased to 0 .83 (95% CI:0 .80-0 .87 ,Z=2 .45 ,P=0 .01) ,with the sensitivity of 75 .01% and specificity of 79 .32% in predicting 3‐year HCC development .To predict the development of HBV‐related HCC within 5 years ,a total of 159 (65 HCC cases and 94 non‐HCC controls) were enrolled .The AUC of REACH‐B scoring model was 0 .79 (95% CI:0 .72-0 .87) ,with the sensitivity of 73 .60% and specificity of 75 .43% .The R‐AFP scoring model had an AUC of 0 .84 (95% CI:0 .77-0 .90 ,Z=2 .70 ,P=0 .006) ,with the sensitivity of 83 .12%and specificity of 77 .89% .Conclusion Combination of AFP or AFP‐L3% may optimize the predictive values of REACH‐B scoring model in predicting 3‐year and 5‐years risks of developing HBV‐related HCC .