FIB-4及APRI指数对慢性乙型肝炎患者肝纤维化严重程度的评估价值

目的探讨基于4因子的纤维化指数(FIB-4)、天门冬氨酸氨基转移酶(AST)/血小板(PLT)比值(APRI指数)对慢性乙型肝炎(CHB)患者肝纤维化严重程度的评估价值。方法 218例CHB患者为研究对象,根据肝纤维化分期,分为S0~S2组(n=120)及S3~S4组(n=98),比较2组患者的一般资料、实验室指标、FIB-4指数及APRI指数的差异;采用Spearman相关分析对两种指数模型与肝纤维化进行相关分析;绘制受试者工作特征(ROC)曲线评估FIB-4及APRI指数在CHB患者肝纤维化分级大于或等于S2、≥S3及S4时的诊断性能,计算曲线下面积、灵敏度、特异度及最佳截断值,并比较FIB-4指数与APRI指数在评估不同严重程度肝纤维化的效能差异。结果肝纤维化分级大于或等于S2时,FIB-4指数的诊断价值明显优于APRI指数(Z=1.998,P=0.046),而对于肝纤维化分级大于或等于S3(Z=1.177,P=0.239)或S4(Z=0.267,P=0.789)时,FIB-4指数与APRI指数的诊断价值一致。结论 FIB-4指数及APRI指数均能有效地评估CHB患者的肝纤维化严重程度,但对于肝纤维化早期患者,FIB-4指数的评估价值更高。

Value of FIB-4 and APRI index in evaluating the severity of liver fibrosis among patients with chronic hepatitis B

Objective To explore the value of FIB-4 and APRI index on evaluating the severity of liver fibrosis among patients with chronic hepatitis B(CHB).Methods A total of 218 CHB were enrolled in the study.Based on the staging of liver fibrosis,the patients were divided into 2 groups as S0-S2 group(n=120) and S3-S4 group(n=98).Differences in clinical data,laboratory indexes,FIB-4 and APRI index were compared between two groups.The correlation between FIB-4 index,APRI index and liver fibrosis were analyzed by Spearman correlation test.Receiver operator curve(ROC) test was used to determine the evaluating value of FIB-4 index and APRI index for the severity of liver fibrosis.Results To evaluate the staging≥S2 of liver fibrosis,the value of FIB-4 index was better than APRI index(Z=1.998,P=0.046).And to evaluate the staging≥S3 and S4 of liver fibrosis,the value of FIB-4 index for evaluating the staging≥S3(Z=1.177,P=0.239) or S4(Z=0.267,P=0.789) was the same as APRI index.Conclusion FIB-4 index and APRI index are both effective on evaluating the severity of liver fibrosis among patients with CHB,but the value of FIB-4 index is better than APRI index for evaluating early liver fibrosis.