FIB-4、APRI指数对自身免疫性肝炎肝脏炎症坏死的预测价值

The Predictive Value of FIB-4 and APRI Index for Liver Inflammation and Necrosis of Autoimmune Hepatitis

目的通过分析自身免疫性肝炎(AIH)患者的血清学指标,探讨基于4项因素的肝纤维化指数(FIB-4)和天冬氨酸氨基转移酶-血小板比在指数(APRI)对AIH肝脏炎症坏死程度的预测价值。方法选取2011年11月~2019年8月在我院经肝活检确诊的50例AIH患者,根据慢性肝炎分级分期标准,病理学分期≥G1、≥G2和≥G3分别定义为轻度炎症坏死、明显炎症坏死和严重炎症坏死,另选48例健康人群作为对照组,归为G0期,收集年龄、PLT、ALT和AST等指标,计算FIB-4、APRI指数。结果不同肝脏炎症坏死程度PLT、ALT、AST、FIB-4、APRI比较,差异有统计学意义(P<0.05);PLT和ALT为明显炎症坏死(≥G2)的独立预测因子。APRI对轻度炎症坏死(≥G1)和明显炎症坏死(≥G2)的诊断效能最高,受试者工作特征曲线下面积(AUROC)分别为0.976,0.941,敏感度分别为94.00%,95.35%,特异度分别为97.92%,87.27%;FIB-4对严重炎症坏死(≥G3)的诊断效能最高,AUROC为0.905,敏感度为92.86%,特异度为82.14%。结论 FIB-4、APRI指数对AIH炎症坏死程度具有显著预测意义,可能是监测AIH炎症坏死程度的一种简便标记物。

Objective To analyze the serum index of patients with autoimmune hepatitis(AIH) andexplore the predictive value of liver fibrosis index based on 4 factors(FIB-4) and aspartate aminotransferase-platelet ratio index(APRI) for the degree of liver inflammation and necrosis. Methods 50 patients with AIH diagnosed by liver biopsy in our hospital from November 2011 to August 2019 were selected. According to the classification criteria for chronic hepatitis, pathological staging≥G1,≥G2,and≥G3 were defined as mild inflammatory necrosis, significant inflammatory necrosisand severe inflammatory necrosis.Another 48 healthy people were selected as the control group and classified as G0 stage. The indicators such as age, PLT, ALT and AST were collected to calculate FIB-4 and APRI index.Results There was statistically significant difference found in PLT, ALT, AST, FIB-4 and APRI between patients with different inflammation stages(P<0.05).PLT and ALT wereindependent predictors of significant inflammatory necrosis(≥G2).APRI had the highest diagnostic efficiencyfor mild inflammatory necrosis(≥G1) and significant inflammatory necrosis(≥G2),and the area under the receiver operating characteristic curve(AUROC) was 0.976,0.941,the sensitivity was 94.00%, 95.35%, andthe specificity was 97.92% and 87.27%,respectively.FIB-4 had the highest diagnostic efficiency for severe inflammatory necrosis(≥G3) with AUROC of 0.905,sensitivity of 92.86%,and specificity of 82.14%.Conclusion FIB-4 and APRI index have significant predictivevalue for the degree of inflammatory necrosis of AIH, and may be convenient markers for monitoring the degree of inflammatory necrosis of AIH.