APRI评分对慢性乙型肝炎肝纤维化程度的诊断及预测价值

Value of aspartate aminotransferase-to-platelet ratio index in diagnosis and prediction of liver fibrosis degree in patients with chronic hepatitis B

目的评估APRI(AST与PLT比值指数)对慢性乙型肝炎肝纤维化的诊断及预测价值。方法收集2014年1月-2016年12月在西安医学院第一附属医院首次诊断且未经治疗的慢性乙型肝炎患者69例,其中HBeAg阳性37例,阴性32例,行肝穿刺活组织检查,病理组织学方法评价肝组织炎症及纤维化程度。计算APRI,绘制受试者工作特征曲线,并分析与肝组织纤维化程度的关系。正态分布的计量资料两组间比较采用独立样本t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验。计数资料两组间比较采用χ~2检验。结果 HBeAg阴性组患者的APRI[0.890(0.370~3.000)]高于HBeAg阳性组[0.520(0.355~0.652)],差异有统计学意义(Z=-2.024,P=0.025);不同肝纤维化程度的APRI比较,差异有统计学意义(χ~2=10.004,P=0.040)。APRI预测中重度肝纤维化(≥F2)的cut-off值为1.06,受试者工作特征曲线下面积为0.673(95%可信区间:0.426~0.920)。结论 APRI对于慢性乙型肝炎患者肝纤维化程度和分期具有较好的诊断及预测价值。

Objective To investigate the value of aspartate aminotransferase-to-platelet ratio index（ APRI） in the diagnosis and prediction of liver fibrosis degree in patients with chronic hepatitis B（ CHB）. Methods A total of 69 treatment-na6 ve CHB patients who were diagnosed in The First Affiliated Hospital of Xi＇an Medical University from January 2014 to December 2016 were enrolled,and among these patients,37 had positive HBeAg and 32 had negative HBeAg. Liver biopsy was performed,and a histopathological method was used to evaluate liver inflammation and fibrosis degree. APRI was calculated,the receiver operating characteristic（ ROC） curve was plotted,and the correlation between APRI and liver fibrosis degree was analyzed. The independent samples t-test was used for normally distributed continuous data between two groups,the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between groups. Results The HBeAg-negative group had a significantly higher APRI than the HBeAg-positive group[0. 890（ 0. 370-3. 000） vs 0. 520（ 0. 355-0. 652）,Z =-2. 024,P = 0. 025],and there was a significant difference in APRI between patients with different liver fibrosis degrees（ χ~2= 10. 004,P = 0. 040）. The cut-off value of APRI for predicting severe liver fibrosis（ ≥F2） was 1. 06,and the area under the ROC curve was 0. 673（ 95% CI： 0. 426-0. 920）. Conclusion APRI has a good value in the diagnosis and prediction of liver fibrosis degree and stage in patients with CHB.