APRI、FIB-4联合对慢性乙型肝炎患者显著肝纤维化的诊断价值

Diagnostic Value of APRI Combined With FIB-4 for Significant Liver Fibrosis in Patients With Chronic Hepatitis B

背景:APRI、FIB-4诊断慢性乙型肝炎患者肝纤维化程度的准确性不高,尤其是对显著肝纤维化(F≥2)。无创肝纤维化模型联合诊断已成目前研究的热点,但APRI联合FIB-4的诊断价值尚不明确。目的:探讨APRI、FIB-4联合对慢性乙型肝炎患者显著肝纤维化的诊断价值。方法:选取2011年1月—2016年10月新疆军区总医院171例慢性乙型肝炎患者,检测肝生化、血常规,行肝穿刺活检。计算APRI、FIB-4,绘制ROC曲线,确定APRI、FIB-4诊断显著肝纤维化的临界值,建立APRI和FIB-4联合诊断的模式。结果:随着肝纤维化程度的加重,APRI、FIB-4逐步升高,组间相比差异有统计学意义(P<0.05)。APRI和FIB-4的ROC曲线下面积(AUC)分别为0.812、0.770。FIB-4诊断显著肝纤维化的敏感性优于APRI。APRI联合FIB-4诊断显著肝纤维化的敏感性、特异性、阴性预测值、阳性预测值和准确性均优于两者单独使用,且模式二的诊断特异性、准确性优于模式一。结论:APRI、FIB-4联合可提高显著肝纤维化的诊断准确性。

Background： The diagnostic accuracy of APRI and FIB-4 for liver fibrosis in patients with chronic hepatitis B is not high,especially for significant liver fibrosis（ F ≥2）. Noninvasive diagnosis for liver fibrosis has become a research hot spot; and the diagnostic value of APRI combined with FIB-4 is not clear. Aims： To investigate the diagnostic value of APRI combined with FIB-4 for significant liver fibrosis in patients with chronic hepatitis B. Methods： A total of 171 patients with chronic hepatitis B from January 2011 to October 2016 at General Hospital of Xinjiang Military Region were enrolled. Liver biochemical indices,routine blood test and liver biopsy pathology were performed. APRI and FIB-4 were calculated,ROC curve was drawn,and cutoff value of APRI and FIB-4 for diagnosing significant liver fibrosis was determined,and mode of APRI combined with FIB-4 for diagnosing significant liver fibrosis was established. Results： With the increase in degree of liver fibrosis,APRI and FIB-4 were gradually increased（ P〈0. 05）. Area under ROC curve（ AUC） for APRI and FIB-4 were 0. 812 and 0. 770,respectively. The sensitivity of FIB-4 for diagnosing significant liver fibrosis was higher than that of APRI. Sensitivity,specificity,negative predictive value,positive predictive value,and accuracy of APRI combined with FIB-4 for diagnosing significant liver fibrosis were superior to APRI or FIB-4 used alone;and the specificity,accuracy of mode 2 were superior to mode 1. Conclusions： APRI combined with FIB-4 can increase the accuracy for diagnosing significant liver fibrosis.