Fibroscan、APRI及FIB-4用于HBV相关肝硬化的诊断价值研究

The research on the diagnostic value of Fibroscan,APRI and FIB-4 in HBV-related cirrhosis

目的探讨Fibroscan、APRI及FIB-4用于乙型肝炎病毒(HBV)相关肝硬化诊断的诊断价值。方法纳入2013年3月至2016年3月就诊的HBV相关肝硬化患者129例(肝硬化组),同时设置慢性乙型肝炎患者116例作为对照(CHB组)。患者就诊时收集一般资料及常规实验室指标,根据公式计算APRI、FIB-4值。固定1名医生对患者进行Fibroscan检测,记录肝硬度值(LSM)。分析临床指标之间的相关性,并使用ROC曲线检测LSM、APRI及FIB-4用于区别诊断CHB与HBV相关肝硬化的价值。结果肝硬化组患者LSM、APRI及FBI-4显著高于CHB组,差异有统计学意义(P<0.05)。肝硬化组中,LSM与ALT、AST、APRI、FIB-4呈正相关(r值分别为0.241、0.283、0.417、0.485,P<0.05),与PLT呈负相关(r=-0.305,P<0.05);CHB组中LSM与各项指标均无相关性(P>0.05)。LSM、APRI及FIB-4诊断肝硬化的AUC分别为0.831(95%CI:0.780~0.881)、0.717(95%CI:0.651~0.782)、0.715(95%CI:0.650~0.780)。结论 Fibroscan、APRI及FIB-4均可用于区别诊断低炎症活动CHB及HBV相关肝硬化,且Fibroscan诊断效能优于APRI及FIB-4。

Objective To investigate the diagnostic value of Fibroscan,APRI and FIB-4 in patients with hepatitis B virus（ HBV） related cirrhosis. Methods A total of 129 patients with HBV-related cirrhosis（ cirrhosis group） and 116 patients with chronic hepatitis B（ CHB group） who were treated in our hospital from March 2013 to March 2016 were enrolled in the study. The patient＇s general data and routine laboratory parameters were collected,and APRI and FIB-4 were calculated according to formulas. The levels of Fibroscan were detected and liver stiffness measurement（ LSM） was performed. The correlation among clinical parameters was analyzed,and ROC curve was used to evaluate the diagnostic value of LSM,APRI and FIB-4 in differential diagnosis between CHB and HBV-related cirrhosis. Results The levels of LSM,APRI and FIB-4 in cirrhosis group were significantly higher than those in CHB group（ P〈 0. 05）. In cirrhosis group,the levels of LSM were positively correlated with those of ALT,AST,APRI and FIB-4（ r = 0. 241,0. 283,0. 417,0. 485,respectively,P 〈0. 05）,however,which were negatively correlated with those of PLT（ r =-0. 305,P 〈0. 05）. In CHB group there was no obvious correlation between LSM and the other parameters（ P〉 0. 05）. The AUC value of LSM,APRI and FIB-4 in diagnosis of cirrhosis was 0. 831（ 95% CI： 0. 780 ~ 0. 881）,0. 717（ 95% CI： 0. 651 ~ 0. 782） and 0. 715（ 95% CI： 0. 650 ~ 0. 780）,respectively. Conclusion The Fibroscan,APRI and FIB-4 can be used to diagnose CHB with less inflammation activity and HBV-related cirrhosis,moreover,the diagnostic value of Fibroscan is superior to that of APRI or FIB-4.