APRI指数对定西地区感染HCV的供血员肝纤维化的诊断价值

目的评价并筛选出适合献血后感染丙型肝炎人群,基于临床常见生化指标的肝纤维化无创预测模型。方法对甘肃省定西地区120例既往供血员丙型肝炎感染患者进行肝穿刺病理肝纤维化评分,检测临床常用生化指标及血清纤维化4项（PCⅢ、CⅣ、HA、LN）,计算APRI指数、Sheth指数、FibroQ指数、FIB-4指数。以肝穿刺病理为金标准,评价上述指标对肝纤维化程度的诊断效能。结果随着肝纤维化程度加重,APRI指数、FibroQ指数、FIB-4指标、PCⅢ、CⅣ、HA的数值增加,其中APRI指数与肝脏穿刺病理分期的相关性良好（r=0.446,P〈0.001）,对明显肝纤维化（≥S2）的诊断效能最高,曲线下面积（AUC）为0.722,其诊断敏感度为57.1%,特异性为78.2%。结论 APRI指数对肝纤维化≥S2有一定的鉴别作用,可作为未行肝穿刺病理检查患者的一个有益补充。

Diagnostic value of the APRI index for liver fibrosis in a Chinese patients population with chronic hepatitis C acquired from blood transfusion

Objective To evaluate the diagnostic efficacy of various newly developed non-invasive fibrotic predictive models based on measurements of common biochemical indices in a group of ethnic Chinese patients with long-standing chronic hepatitis C（CHC） infection acquired by transfusion.Methods Between July 2010 and June 2011,120 of the monitored residents of Dingxi District of Gansu Province who had acquired hepatitis C infection via the regional practice of untested whole blood or plasma transfusion during the years of 1992-1995 were recruited for the current study.Each participant underwent liver biopsy for histological evaluation of liver fibrosis（S1-S4 progressive stages,from mild fibrosis to early cirrhosis）.Each participant also provided serum samples for biochemical measurement of fibrotic indicators,including hyaluronic acid（HA）,type Ⅲ procollagen protein（PCⅢ）,laminin（LN）,and type IV collagen（CⅣ）.In addition,aspartate aminotransferase（AST）,platelet count（PLT）,alanine aminotransferase（ALT）,prothrombin time（PT）,and international normalized ratio（INR） were measured to calculate the various non-invasive fibrotic predictive models： AST-to-PLT ratio index（APRI）,the Sheth index（AST/ALT）,the FibroQ index（10×（age×AST×PT INR）/（ALT×PLT]）,and the FIB-4 index（age×AST）/（PLT×ALT1/2）]）.Using the pathologic results as the reference standards,the diagnostic efficacies of these four non-invasive fibrotic predictive models were evaluated by Spearman＇s rank correlation coefficient.Accuracies of the four were compared by constructing receiver operating characteristic（ROC） curves and analyzing their sensitivities,specificities and area under the curves（AUCs）.Results The APRI,FibroQ and FIB-4 indexes,and the levels of PCⅢ,CⅣ,and HA increased in conjunction with progressive stages of liver fibrosis.However,only the APRI showed significant correlation to liver fibrosis stage（r=0.446,P0.001）.The APRI index also had a better ability for distinguishing the moderatefibrosis stage from the severe fibrosis stage,as indicated by an AUC of 0.722,diagnostic sensitivity of 57.1%,and specificity of 78.2%.Conclusion APRI may be an effective and less traumatic alternative approach to surgical biopsy for diagnosing fibrosis,especially at stages greater than S2,in ethnic Chinese with CHC.