APRI、FIB-4聯合對慢性乙型肝炎患者顯著肝纖維化的診斷價值*

馬曉輝 張 新 游 云 蔣麗麗 趙 金 阿依古力·阿不力米提 聶占國#

石河子大學醫學院1(832000) 中國人民解放軍新疆軍區總醫院消化科2

APRI、FIB-4聯合對慢性乙型肝炎患者顯著肝纖維化的診斷價值*

馬曉輝1,2張 新2游 云2蔣麗麗2趙 金2阿依古力·阿不力米提2聶占國2#

石河子大學醫學院1(832000)中國人民解放軍新疆軍區總醫院消化科2

背景：APRI、FIB-4診斷慢性乙型肝炎患者肝纖維化程度的準確性不高，尤其是對顯著肝纖維化(F≥2)。無創肝纖維化模型聯合診斷已成目前研究的熱點，但APRI聯合FIB-4的診斷價值尚不明確。目的：探討APRI、FIB-4聯合對慢性乙型肝炎患者顯著肝纖維化的診斷價值。方法：選取2011年1月—2016年10月新疆軍區總醫院171例慢性乙型肝炎患者，檢測肝生化、血常規，行肝穿刺活檢。計算APRI、FIB-4，繪制ROC曲線，確定APRI、FIB-4診斷顯著肝纖維化的臨界值，建立APRI和FIB-4聯合診斷的模式。結果：隨著肝纖維化程度的加重，APRI、FIB-4逐步升高，組間相比差異有統計學意義(P<0.05)。APRI和FIB-4的ROC曲線下面積(AUC)分別為0.812、0.770。FIB-4診斷顯著肝纖維化的敏感性優于APRI。APRI聯合FIB-4診斷顯著肝纖維化的敏感性、特異性、陰性預測值、陽性預測值和準確性均優于兩者單獨使用，且模式二的診斷特異性、準確性優于模式一。結論：APRI、FIB-4聯合可提高顯著肝纖維化的診斷準確性。

APRI； FIB-4； 乙型肝炎, 慢性； 肝硬化； 診斷

Correspondenceto: NIE Zhanguo, Email: niezg@sina.com

Background: The diagnostic accuracy of APRI and FIB-4 for liver fibrosis in patients with chronic hepatitis B is not high, especially for significant liver fibrosis (F≥2). Noninvasive diagnosis for liver fibrosis has become a research hot spot; and the diagnostic value of APRI combined with FIB-4 is not clear.Aims: To investigate the diagnostic value of APRI combined with FIB-4 for significant liver fibrosis in patients with chronic hepatitis B.Methods: A total of 171 patients with chronic hepatitis B from January 2011 to October 2016 at General Hospital of Xinjiang Military Region were enrolled. Liver biochemical indices, routine blood test and liver biopsy pathology were performed. APRI and FIB-4 were calculated, ROC curve was drawn, and cutoff value of APRI and FIB-4 for diagnosing significant liver fibrosis was determined, and mode of APRI combined with FIB-4 for diagnosing significant liver fibrosis was established.Results: With the increase in degree of liver fibrosis, APRI and FIB-4 were gradually increased (P<0.05). Area under ROC curve (AUC) for APRI and FIB-4 were 0.812 and 0.770, respectively. The sensitivity of FIB-4 for diagnosing significant liver fibrosis was higher than that of APRI. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of APRI combined with FIB-4 for diagnosing significant liver fibrosis were superior to APRI or FIB-4 used alone; and the specificity, accuracy of mode 2 were superior to mode 1.Conclusions: APRI combined with FIB-4 can increase the accuracy for diagnosing significant liver fibrosis.

KeywordsAPRI; FIB-4; Hepatitis B, Chronic; Liver Cirrhosis; Diagnosis

目前診斷肝纖維化的“金標準”仍是肝活檢，但肝活檢為有創操作，存在取樣誤差、不同病理閱片者主觀偏倚等缺點[1-3]。因此，近年肝纖維化的無創診斷已成為研究熱點，其中APRI、FIB-4應用較為廣泛[4]。但有報道[5]認為，APRI、FIB-4單獨使用診斷肝纖維化的準確性不超過75%，誤診率和漏診率較高。目前關于APRI、FIB-4聯合應用的報道較少見，本研究探討兩者聯合對慢性乙型肝炎患者顯著肝纖維化(F≥2)的診斷價值，旨在提高慢性乙型肝炎患者顯著肝纖維化的診斷準確性。

對象與方法

一、研究對象