AAR和API评估慢性乙型病毒性肝炎肝纤维化临床价值的比较

目的比较谷草转氨酶-谷丙转氨酶的比值（AAR）和年龄-血小板指数（API）对慢性乙型病毒性肝炎肝纤维化的临床价值。方法172例慢性乙型病毒性肝炎患者均接受肝组织病理检查，并同时检测肝功能和血常规，用ROC曲线评价AAR和API诊断慢性乙型病毒性肝炎肝纤维化的能力。结果肝纤维化S0、S1、S2、S3和S4的AAR无显著差异（P〉0．05），肝纤维化分期与AAR的相关系数（rs）=0．107（P〉0．05），ROC曲线分析显示AAR诊断显著肝纤维化和肝硬化的AUC均〈0．7；肝纤维化S4的API高于S0、S1、S2和s3（P〈0．01），肝纤维化分期与API的rs=0．314（P〈0．01），ROC曲线分析显示API诊断显著肝纤维化的AUC〈0．7（P〉0．05），但诊断肝硬化的AUC达到0．773（P〈0．01），敏感度（SN）达到70．83％，特异度（sP）达到72．18％。结论AAR对于评估慢性乙型病毒性肝炎肝纤维化的临床价值不大；API与肝纤维化分期有一定的相关性，可以用于肝纤维化S4的诊断，但对肝纤维化s1、s2和s3的区分能力有限。

Clinical value of AAR and API in evaluating liver fibrosis of chronic hepatitis B

Objective To compare the clinical value of AAR and API in evaluating liver fibrosis of chronic hepatitis B. Methods There were 172 patients with chronic hepatitis B who were underwent liver biopsy with their liver function and blood routine taken simultaneously. Three different endpoints were studied according to liver fibrosis stages, namely without/light fibrosis （ S0/S1 ） , significant fibrosis （S2/S3/S4） and cirrhosis （S4）. The area under the receiver operating characteristic （ROC） curve （AUC） reflected its diagnostic value. Results There was no significant difference in AAR of fibrosis SO, S1, S2, S3 and S4 （P 〉 0.05）. The correlation coefficient between liver fibrosis stages and AAR was 0. 107 （P 〉 0.05）. The AUC of AAR with significant fibrosis/cirrhosis was low to 0.7. The API of fibrosis S4 was higher than those of fibrosis SO, S1, S2 and S3 （P 〈 0.01 ）. The correlation coefficient between liver fibrosis stages and API was 0. 314 （P 〈 0.01 ）. The AUC of API with cirrhosis attached 0. 773 （P 〈 0.01 ）. However, that of significant fibrosis was low to 0.7 （P 〉 0.05）. Conclusion There is little clinical value with AAR in evaluating liver fibrosis of chronic hepatitis B. There is definite correlation between liver fibrosis stages and API. API can be used for diagnosis of fibrosis S4. However, it can not discriminate fibrosis S1, S2 and S3.