透明质酸、Ⅳ型胶原、APRI及纤维蛋白原-4对乙型肝炎后肝纤维化的诊断价值

HA,Ⅳ-C,APRI and Fib-4 for diagnosis of liver fibrosis effect after Hepatitisb

目的探讨透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、天门冬氨酸氨基转移酶(AST)与血小板(PLT)比值(APRI)、纤维蛋白原-4(Fib-4)在乙型肝炎患者肝纤维化诊断中的临床价值。方法采用回顾性研究方法,选取2018年6月至2020年9月在唐山市工人医院治疗的182例乙型肝炎患者。以肝硬度METAVIR评分进行肝硬化分期,F0期51例,F1期47例,F2期38例,F3期30例,F4期16例。比较不同肝纤维化分期患者的基础资料,对比不同肝硬化分期患者的血清HA、Ⅳ-C、APRI、Fib-4指标,并对各项指标诊断肝纤维化的效能进行分析。结果F0~F4分期患者的性别构成比差异无统计学意义(P>0.05),而随着分期增加,年龄与病程明显升高,差异均有统计学意义(P<0.05)。HA、Ⅳ-C、APRI、Fib-4随着肝纤维化分期增加而不断明显升高,差异均有统计学意义(P<0.05)。HA、Ⅳ-C、APRI、Fib-4均与肝纤维化分期存在显著的正相关关系(r=0.32、0.49、0.52、0.66,P<0.01)。HA、Ⅳ-C、APRI、Fib-4联合检测对肝纤维化诊断的敏感度、特异度为95.76%、91.54%。显著高于单项指标检测(HA:61.82%、70.63%,Ⅳ-C:70.31%、84.43%,APRI:74.25%、90.05%;Fib-4:71.63%、84.78%)。结论HA、Ⅳ-C、APRI、Fib-4均与乙型肝炎患者的肝纤维化有较为明显的相关性,联合检测对诊断肝纤维化有较高的敏感性与特异度,可以作为肝纤维化诊断的重要参考指标。

Objective To study the hyaluronic acid(HA),collagen typeⅣ(Ⅳ-C),aspartate aminotransferase(AST)and platelet(PLT)ratio(APRI),fibrinogen-4(Fib-4)in hepatitis b patients'clinical value in the diagnosis of liver fibrosis.Methods Using retrospective research methods,182 patients with hepatitis B treated in Tangshan Workers'Hospital from June 2018 to September 2020 were selected.Liver cirrhosis staging according to liver hardness METAVIR score,there were 51 cases in F0 stage,47 cases in F1 stage,38 cases in F2 stage,30 cases in F3 stage,and 16 cases in F4 stage.The liver stiffness METAVIR score was used to stage liver cirrhosis,and the basic data of different liver fibrosis stages were compared and different Serum HA,Ⅳ-C,APRI,Fib-4 indicators of patients with liver cirrhosis stage,and analysis of the efficacy of each indicator in diagnosing liver fibrosis.Results There was no significant difference in the gender composition ratio of patients with F0 to F4 stages(P>0.05),while the age and course of the disease continued to increase significantly with the increase of liver fibrosis stages(P<0.05).HA,IV-C,APRI,Fib-4 increased significantly with the increase of liver fibrosis stages,and the differences were statistically significant(P<0.05).HA,IV-C,APRI,Fib-4 all have a significant positive correlation with liver fibrosis stage(r=0.32,0.49,0.52,0.66,P<0.01).The sensitivity and the specificity of the combined detection of HA,Ⅳ-C,APRI,and Fib-4 for the diagnosis of liver fibrosis was 95.76%,91.54%,which was higher than single index(HA:61.82%,70.63%,Ⅳ-C:70.31%,84.43%,APRI:74.25%,90.05%;Fib-4:71.63%,84.78%).Conclusion HA,Ⅳ-C,APRI,Fib-4 patients with hepatitis b liver fibrosis has relatively obvious correlation,the joint detection of liver fibrosis significantly have higher sensitivity and specific degrees,can be used as important reference index of the diagnosis of liver fibrosis.