四种评分系统对慢性乙型肝炎患者肝纤维化的预测价值

目的探讨S指数和FIB-4两种新型非创伤性评分系统对慢性乙型肝炎（CHB）患者肝纤维化程度的预测价值，并比较其与传统评分系统APRI和Forns之间的差异。方法收集2006年1月-2011年12月南京医科大学附属第一医院和复旦大学附属华山医院361例CHB确诊患者的临床、实验室检查及病理资料等。根据公式分别计算APRI、Forns、S指数和FIB4，以肝组织病理学检查作对照，根据受试者T作特征曲线（AUROCs）分别评价四种评分系统对肝纤维化的诊断价值。采用曲线下面积Z检验评价四种评分系统的效率。结果APRI、Forns、S指数以及FIB-4诊断显著肝纤维化（≥S2）的AUC曲线下面积分别为（0．737±0．027）、（0．716±0．028）、（0．745±0．026）和（0．781±0．025），其中FIB4指数以1．62为界值，诊断显著纤维化的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为59．3％、85．8％、89．4％和51．2％，优于Forns指数（Z=3．28，P=0．001）；而对S4（肝硬化）的AUC曲线下面积分别为（0．687±0．035）、（0．792±0．028）、（0．863±0．024）和（0．832±0．025），其中S指数以1．06为界值，诊断肝硬化的灵敏度、特异性、PPV和NPV分别为77．9％、85．5％、59．4％和93．5％，诊断效率优于APRI和Forns（Z=6．74和3．21，P〈0．01）。结论四种评分系统在临床应用中均简单易行，预测结果相对可靠，其中nB4和s指数对显著纤维化及肝硬化的预测效果优于APRI和Forns评分，在一定程度上可替代肝组织活检。

Four noninvasive score systems for diagnosis of liver fibrosis in patients with chronic hepatitis B

Objective To assess the value of S index and FIB-4 for diagnosis of liver fibrosis in patients with chronic hepatitis B （CHB） by comparing with traditional indexes APRI and Forns. Methods A total of 361 patients with confirmed CHB from the First Hospital of Nanjing Medical University and Huashan Hospital Affiliated to Fudan University during January 2006 and December 2011 were enrolled in the study. The clinical, laboratory and pathological data of patients were collected. Four noninvasive score systems APRI, Forns, S index and FIB-4 were computed. With liver biopsy as the gold standard, the area under the ROC curve （AUROC） was used to assess the value of above 4 score systems in diagnosis of liver fibrosis, and Z test was performed to evaluate the effectiveness of above systems. Results The areas under ROC curve （AUCs） of APRI, Forns, S index and FIB4 for significant fibrosis （ t〉 A2 ） were （0. 737 ± 0. 027）, （0. 716 ±0. 028）, （0. 745 ±0. 026） and （0. 781 ±0. 025 ）, respectively. When the cut off value of FIB-4 was set at 1. 62, the sensitivity, specificity, positive predictive value （PPV） and negative predietive value （NPV） for diagnosis of significant fibrosis were 59.3% , 85.8% , 89.4% and 51.2% , respectively, which were better than Forn index （Z = 3.28, P = 0. 001 ）. While for S4 （cirrhosis） theAUCs of APRI, Forns, S index and FIB4 were （0. 687 ± 0. 035 ）, （0. 792 ± 0. 028 ）, （ 0. 863± 0. 024 ） and （0. 832 ± 0. 025）, respectively. When the cut off value of S index was set at 1.06, the sensitivity, specificity, PPV and NPV for diagnosis of cirrhosis were 77. 9%, 85. 5%, 59. 4% and 93. 5%, respectively, whieh were better than APRI and Forns （Z = 6.74 and 3.21, P 〈 0.01 ）. Conehtsions APRI, Forns, S index and FIB-4 are simple and accurate methods for assessing liver fibrosis. FIB4 and S index are better than APRI and Forns in diagnosis of significant fibrosis and cirrhosis, which may replace liver biopsy in certain extend.