无创性指标对慢性乙型肝炎严重程度的预测价值

Study on the predictive value of noninvasive indexes for the severity of chronic hepatitis B

目的:探讨天门冬氨酸氨基转移酶/血小板比值(APRI)、肝纤维化-4指数(FIB-4)、Forns指数、APGA指数、红细胞平均分布宽度-血小板比率(RPR)等无创性指标对慢性乙型肝炎(CHB)患者严重程度的预测价值。方法:回顾性收集2016年4月至2020年7月行肝穿刺活检的CHB患者846例,收集患者基础资料及常规实验室检查结果,分析APRI、FIB-4、Forns、APGA、RPR水平与CHB患者肝脏炎症活动度和纤维化程度的关系。结果:不同肝组织病理分级及分期患者APRI、FIB-4、Forns、APGA、RPR评分比较差异均有统计学意义(P<0.05)。APRI、FIB-4、Forns、APGA、RPR五种无创性指标与肝组织病理分级和分期之间呈正相关(P<0.01)。APRI、FIB-4、Forns、APGA、RPR诊断肝显著纤维化的AUC分别为0.794、0.772、0.746、0.895、0.864,各指标联合诊断AUC为0.931。结论:RPR、APGA对CHB肝纤维化程度具有较好的预测价值,值得临床推广和应用,但为提高预测的准确性,可同时联合应用其他无创指标共同评价。

Objective:To investigate the predictive value of aspartate aminotransferase/platelet ratio(Apri),liver fibrosis-4 index(FIB-4),forns index, APGA index and RPR in predicting the severity of chronic hepatitis B(CHB).Methods:A total of 846 patients with CHB who underwent liver biopsy from April 2016 to July 2020 in our hospital were retrospectively collected.The general information and routine laboratory examination results were collected.The relationship between the levels of Apri, FIB-4,forns, APGA,RPR and the degree of liver inflammation and fibrosis in CHB patients were analyzed. Results:There were significant differences in Apri, FIB-4,forns, APGA and RPR scores in patients with different liver pathological grades and stages(all P<0.05).There was a positive correlation between the APRI, FIB-4,Forns, APGA, RPR and the pathological grade and stage of liver tissue(P<0.01).The AUC of Apri, FIB-4,forns, APGA and RPR in the diagnosis of liver fibrosis were 0.794,0.772,0.746,0.895 and 0.864,respectively, and the AUC of combined diagnosis was 0.931. Conclusion:RPR and APGA have good predictive value for the degree of liver fibrosis in CHB,which is worthy of clinical promotion and application.However, in order to improve the accuracy of prediction, Other noninvasive indexes can be used simultaneously for joint evaluation.