天冬氨酸转氨酶与血小板比值在转氨酶正常值上限两倍以下慢性乙型肝炎病毒感染者中的临床应用评价

Clinical utility of aspartate aminotransferase to platelet ratio index in chronic hepatitis B virus infection with transaminase less than two times of upper limits of normal

目的评价AST与血小板比值（APRI）在判断转氨酶（AST和ALT）正常值上限2倍以下的慢性HBV感染者肝纤维化程度中的作用，便于指导临床抗病毒治疗。方法选择临床诊断慢性HBV感染且AST、ALT均〈2倍正常值上限的患者349例，行常规实验室检查和肝脏活组织检查，计算出APRI，比较不同的肝纤维化程度与APRI的关系。应用受试者工作特征（ROC）曲线评价APRI模型的诊断价值，采用Spearman等级相关分析判断APRI与肝脏纤维化分期的相关性。结果APRI≥0．273时，患者有显著肝纤维化，ROC曲线下面积为0．641，灵敏度为48．3％，特异度为75．7％，阳性预测值为73．9％；APRI≥0．311时，患者为肝硬化，ROC曲线下面积为0．771，灵敏度为68．6％，特异度为76．8％，阴性预测值为93．5％。在HBVDNA为1×10^3～1×10^5拷贝／mL组中，APRI≥0．179为明显肝纤维化最优截点（P=0．00），APRI≥0．283为肝硬化最优截点（P=0．00）。Spearman相关分析显示，APRI与肝纤维化分期呈显著正相关性（r=0．370，P％0．01）。结论APRI可用于转氨酶正常值上限2倍以下的慢性HBV感染者肝纤维化程度的判断，APRI≥0．273为有明显肝纤维化（纤维化分期≥S2），对临床选择抗病毒治疗的时机具有一定指导意义。根据HBVDNA水平不同，制定相应的APRI指数评价肝纤维化程度，可提高临床应用价值。

Objective To evaluate the performance of aspartate aminotransferase to platelet ratio index （APRI） in the assessment of fibrosis in chronic hepatitis B virus （HBV） infection patients with transaminase level less than two times of upper limits of normal （ULN）, and to analyze the clinical utility in antiviral therapy. Methods A total of 349 clinically diagnosed chronic HBV infection with alanine aminotransferase （ALT） and aspartate aminotransferase （AST） level less than 2 × ULN were enrolled. Liver biopsy and routine laboratory tests were performed to calculate the ratio of AST to platelet （PLT）, namely the APRI, and to compare the relationship between liver fibrosis and APRI. Diagnostic performance of APRI model was assessed by using receiver operating characteristic （ROC） curves and area under the ROC curve （AUC） analysis. Correlation between APRI and liver fibrosis was determined by Spearman rank correlation analysis. Results The AUC of APRIl0. 273 for significant liver fibrosis was 0. 641 with sensitivity of 48.3%, specificity of 75.7% and positive predictive value of 73.9%. The AUC of APRIl0. 311 for cirrhosis was 0. 771 with sensitivity of 68.6%, specificity of 76.8%, and negative predictive value of 93.5 %. In patients with HBV DNA level ranging from 1 × 10% to 1 % 10s copy/mL, the optimal cut-off value of APRI was 0. 179 for significant fibrosis （P=0. 00） and 0. 283 for cirrhosis （P= 0.00）. By Spearman rank correlation analysis, APRI was positively correlated with histologic stages of fibrosis （r= 0. 370, P〈0. 01）. Conclusions APRI can be utilized to assess liver fibrosis in HBV infection with ALT and AST level less than 2 X ULN. APRIl0. 273 （pathologic stages of fibrosis ≥S2） has obvious hepatic fibrosis, which may help physician to select the optimal time for antiviral therapy. APRI may serve as a potential tool for assessing liver fibrosis according to HBV DNA levels.