Fibroscan联合APRI和FIB-4在HBV感染患者治疗中的应用

Fibroscan combined with APRI and FIB-4 in the treatment of patients with HBV infection

目的探讨Fibroscan、天门冬氨酸氨基转移酶-血小板比值(APRI)、FIB-4联合应用在乙型肝炎病毒(HBV)感染患者治疗中的指导价值,旨在提高HBV感染患者肝纤维化程度的诊断准确性,以便采取有效的治疗措施并改善预后。方法选取2018年1月-2018年6月德阳市人民医院感染科收治的HBV感染患者400例作为研究对象,根据APRI、FIB-4模型数值联合Fibroscan检查将患者分为显著肝纤维化(S3~S4)组和轻度肝纤维化组(S1~S2)。所有患者均给予恩替卡韦抗病毒治疗及抗肝纤维化治疗(口服复方鳖甲软肝片)。治疗前、治疗后3、6、12个月分别检测血常规、肝功能等,测算APRI、FIB-4模型数值,并应用Fibroscan测定肝脏硬度值,比较上述指标在两组患者之间、同组患者不同监测时间的变化。结果轻度肝纤维化组共232例,显著肝纤维化组168例,显著肝纤维化组的Fibroscan、血清APRI、FIB-4显著高于轻度肝纤维化组,差异有统计学意义(t=12.105、9.625、10.035,P=0.004、0.015、0.009)。治疗后3、6、12个月两组Fibroscan、APRI、FIB-4水平均低于治疗前(P<0.05);治疗前、治疗后3、6、12个月显著肝纤维化组Fibroscan、APRI、FIB-4水平均高于轻度肝纤维化组(P均<0.05)。治疗后3、6、12个月两组丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血胆汁酸(TBA)、碱性磷酸酶(ALP)水平均低于治疗前(P<0.05);治疗前、治疗后3、6、12个月显著肝纤维化组ALT、AST、TBA、ALP水平均高于轻度肝纤维化组(P均<0.05)。Fibroscan、APRI、FIB-43种诊断方法联合使用时的诊断效能均较3种方法单独使用时显著提高,且对显著肝纤维化患者的诊断效果明显优于轻度肝纤维化患者,差异有统计学意义(P<0.05)。结论Fibroscan、APRI、FIB-4联合应用在HBV感染患者治疗中具有较高的疗效和疗效评估价值,值得临床广泛应用。

Objective To explore the diagnostic and guiding value of Fibroscan,aspartate aminotransferase-platelet ratio(APRI)and Fibrosis-4(FIB-4)in the treatment of patients with hepatitis B virus(HBV)infection,in order to improve the diagnostic accuracy of hepatic fibrosis in patients with HBV infection.Methods 400 patients with HBV infection admitted to our hospital from January 2018 to June 2018 were selected as the research objects.According to APRI,FIB-4 model and Fibroscan test,the patients were divided into significant hepatic fibrosis group(S3-S4)and mild hepatic fibrosis group(S1-S2).All patients were treated with entecavir antiviral therapy and anti-hepatic fibrosis therapy(oral compound Biejia Ruangan Tablet).Blood routine and liver functions were measured before treatment,3 months,6 months and 12 months after treatment.APRI and FIB-4 model values were calculated.Liver stiffness was measured by Fibroscan.The changes of the above indicators were compared between the two groups and at different monitoring times in the same group.Results There were 232 cases in the mild liver fibrosis group,168 cases in the significant liver fibrosis group.Fibroscan,serum APRI and FIB-4 levels in the significant liver fibrosis group were significantly higher than those in the mild liver fibrosis group(t=12.105,9.625,10.035,P=0.004,0.015,0.009).The levels of Fibroscan,APRI and FIB-4 in the two groups at3,6 and 12 months after treatment were lower than those before treatment(P<0.05).The levels of Fibroscan,APRI,and FIB-4 in the significant hepatic fibrosis group were higher than those in the mild hepatic fibrosis group before treatment and at 3,6,and 12 months after treatment(all P<0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood bile acid(TBA),and alkaline phosphatase(ALP)in the two groups at 3,6,and 12 months after treatment were lower than those of before treatment(P<0.05).The levels of ALT,AST,TBA and ALP in the significant hepatic fibrosis group were higher than those in the mild hepatic fibrosis group before treatment and at 3,6,and12 months after treatment(all P<0.05).The diagnostic efficacy of Fibroscan,APRI,and FIB-4 when used in combination was significantly higher than those when the three methods were used alone,and the diagnostic effect of Fibroscan combined with APRI and FIB-4 in patients with significant hepatic fibrosis was significantly better than that of patients with mild hepatic fibrosis,the differences were statistically significant(P<0.05).Conclusion The combined application of Fibroscan,APRI and FIB-4 in the treatment of patients with HBV infection had high diagnostic value and should be worth of wide clinical application.