目的

探讨GGT与Plt比值（GPR）联合中性粒细胞与淋巴细胞比值（NLR）、Plt与淋巴细胞比值（PLR）以及淋巴细胞与单核细胞比值（LMR）在HBV相关肝细胞癌（HBV-HCC）中的诊断价值。

方法

回顾性分析2012年1月至2018年9月中山大学附属第三医院收治的1119例慢性乙型病毒性肝炎（乙肝）、乙肝后肝硬化、HBV-HCC患者临床资料。其中非肝癌组784例，男648例，女136例；年龄18～82岁，中位年龄43岁；肝癌组335例，男303例，女32例；年龄21～83岁，中位年龄54岁。肝癌诊断单因素分析采用Mann-Whitney U检验或χ²检验，单因素分析中P＜0.1的指标经共线性诊断，方差膨胀因子＜5的指标进入Logistic多因素回归可得独立影响因子，用于建立HBV-HCC的Logistic回归模型，其诊断价值采用ROC的曲线下面积（AUC）进行分析。

结果

Logistic多因素回归显示，男性、PLR、GPR和年龄是HBV-HCC的独立危险因素（OR=2.876，1.004，1.151，1.070；P＜0.05），基于以上因素构建的Logistic回归模型的AUC为0.782（敏感度0.740，特异度0.719）。该模型与AFP联合诊断的AUC为0.855，可提高AFP（AUC 0.778）的诊断效能（Z=-5.400，P＜0.05）。

结论

GPR联合PLR的Logistic 回归模型对早期HBV-HCC诊断有一定的临床价值，其与AFP联合可提高AFP的诊断效能。

Objective

To evaluate the diagnostic value of GGT-Plt ratio （GPR） combined with neutrophil-lymphocyte ratio （NLR），Plt-lymphocyte ratio （PLR） and lymphocyte-monocyte ratio （LMR） for HBV-related hepatocellular carcinoma （HBV-HCC）.

Methods

Clinical data of 1119 patients with chronic hepatitis B，post-hepatitis B cirrhosis and HBV-HCC admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to September 2018 were retrospectively analyzed. Among them，784 patients were assigned in the non-HCC group，648 male and 136 female，aged 18-82 years，with a median age of 43 years. 335 cases were included in the HCC group，303 male and 32 female，aged 21-83 years，with a median age of 54 years. Univariate analysis of HCC diagnosis was conducted by Mann-Whitney U test or Chi-square test. In univariate analysis，the parameters with P＜0.1 were used for collinear diagnosis，and the parameters with variance inflation factor of ＜5 were included into multivariate Logistic regression analysis to obtain the independent influencing factors，which were used to establish Logistic regression model for HBV-HCC. The diagnostic value was evaluated by the area under the ROC curve （AUC）.

Results

Multivariate Logistic regression analysis showed that male，PLR，GPR and age were the independent risk factors for HBV-HCC （OR=2.876，1.004，1.151，1.070； P＜0.05）. The AUC of Logistic regression model based on the above factors was 0.782 with a sensitivity of 0.740 and a specificity of 0.719. The AUC of this model combined with AFP was 0.855，which enhanced the diagnostic efficiency of AFP （AUC=0.778）（Z=-5.400， P＜0.05）.

Conclusions

The Logistic regression model based on GPR combined with PLR has certain clinical value for early diagnosis of HBV-HCC. This model in combination with AFP can improve the diagnostic efficiency of AFP.