FIB-4指数对慢性乙型肝炎患者肝纤维化的诊断价值

目的 探讨FIB-4指数对慢性乙型肝炎肝纤维化的诊断价值.方法 212例慢性乙型肝炎患者行肝活检并同时留取血清标本,检测ALT、AST、PLT等指标,并根据其结果结合患者的年龄计算出FIB-4的数值.根据肝纤维化分期设定3个判定点,分别为显著纤维化（S2～S4期）,严重纤维化（S3～S4期）和肝硬化（S4期）.以肝活检病理结果为金标准绘制出FIB-4的受试者工作特征曲线（ROC）,计算曲线下面积（AUC）,评价其对慢性乙型肝炎肝纤维化的诊断价值.结果 212例肝活检患者中S0期3例（1.4%）,S1期49例（23.1%）,S2期66例（31.1%）,S3期50例（23.6%）,S4期44例（20.8%）,即显著纤维化者（S2～S4期）160例（75.5%）,严重纤维化者（S3～S4期）94例（44.3%）,肝硬化者（S4期）44例（20.8%）.FIB-4指数对3个判定点的AUC值分别为0.733（95%（CI：0.660～0.806,P〈0.01）、0.746（95%CI：0.679～0.813,P〈0.01）、0.756（95%CI：0.687～0.825,P〈0.01）.结论 FIB-4指数是一种简单的、准确的、经济的非创性诊断方法,可以较准确地估计慢性乙型肝炎患者有无显著纤维化,使多数患者避免肝穿刺活检.

Value of FIB-4 for the diagnosis of liver fibrosis in chronic hepatitis B

Objective To assess the diagnostic value of FIB-4 in chronic hepatitis B (CHB) by comparing their results with histological features.Methods 212 chronic hepatitis B patients underwent liver biopsy with a blood sample taken simultaneously.The serum level of ALT,AST,PLT were tested.These results together with age of the patients were put into the formula and final results of FIB-4 were computed.Three different endpoints were studied according to liver fibrosis stage,namely significant fibrosis(S2 to S4),extensive fibrosis(S3 to S4)and cirrhosis(S4).With liver biopsy as the gold standard,ROC curves were delineated for different endpoints.The area under the ROC Curves reflected its diagnostic values.Results The distribution of their fibrosis stage was as follows,S0:3(1.4%);S1:49(23.1%);S2:66 (31.1%);S3:50(23.6%);S4:44(20.8%).That means 160 patients(75.5%)had significant fibrosis (S2 to S4),94(44.3%) had extensive fibrosis(S3 to S4)and 44(20.8%)had cirrhosis(S4).The AUCs of FIB-4 for significant fibrosis,extensive fibrosis and cirrhosis were 0.733(95%CI:0.660-0.806,P<0.01),0.746(95%CI:0.679-0.813,P<0.01),0.756(95%CI:0.687-0.825.P<0.01)respectively.Conclusion The FIB-4 index is a simple,accurate and inexpensive methed to assess liver fibrosis in chronic hepatitis and may reduce the need for liver biopsy.