抗病毒治疗对APRI和FIB-4诊断慢性乙型肝炎肝纤维化效能的影响

Effect of antiviral therapy on the efficacy of APRI and FIB-4 in the diagnosis of chronic hepatitis B liver fibrosis

目的 评估天冬氨酸转氨酶和血小板比率指数(aspartate aminotransferase to platelet ratio index, APRI)、纤维化-4指数(fibrosis-4 score,FIB-4)在接受抗病毒治疗的慢性乙型肝炎(chronic hepatitis B, CHB)患者和未接受抗病毒治疗的CHB患者中诊断肝纤维化的准确性。方法 研究对象为2018年10月至2022年12月就诊于延安大学附属医院的CHB患者。使用瞬时弹性成像技术评估肝脏硬度;采用受试者工作特征曲线(receiver operating characteristic, ROC)分析APRI和FIB-4对肝纤维化的诊断效能。结果 共纳入300例患者,男性193例,女性107例;未接受抗病毒治疗的CHB患者90例,接受抗病毒治疗的CHB患者210例。研究人群的中位年龄为50.0岁;根据肝脏硬度,将患者分为非严重肝纤维化和严重肝纤维化;在未抗病毒治疗的CHB患者中,APRI和FIB-4诊断严重肝纤维化的曲线下面积(area under the curve,AUC)分别为0.869和0.829,在抗病毒治疗的CHB患者中,APRI和FIB-4诊断严重肝纤维化的AUC分别为0.822和0.796。结论 在接受抗病毒治疗的CHB患者中,尽管APRI和FIB-4有轻微的降低,但其诊断肝纤维化的准确性仍然较优。

Objective Assess the accuracy of aspartate aminotransferase to platelet ratio index(APRI)and fibrosis 4 score(FIB-4)in diagnosing liver fibrosis in patients with chronic hepatitis B(CHB)receiving antiviral therapy and in patients with CHB not receiving antiviral therapy.Methods The subjects were patients with CHB who attended in Affiliated Hospital of Yan'an University between October 2018 and December 2022.The liver stiffness measure was evaluated using transient elastography technology.The efficacy of APRI and FIB-4 in the diagnosis of liver fibrosis at different levels was analyzed using the receiver operating characteristic(ROC)curve.Results A total of 300 patients were included,including 193 males and 107 females;there were 90 CHB patients who did not receive antiviral treatment and 210 CHB patients who received antiviral treatment.The median age of the study population was 50.0 years old.According to the liver stiffness measure,the patients were divided into non-significant liver fibrosis and significant liver fibrosis.In CHB patients without antiviral treatment,the areas under the curve(AUC)of APRI and FIB-4 for diagnosing severe liver fibrosis were 0.869 and 0.829,respectively.In CHB patients with antiviral treatment,the AUC of APRI and FIB-4 for diagnosing severe liver fibrosis was 0.822 and 0.796,respectively.Conclusion Although there is a slight decrease in APRI and FIB-4 in patients with CHB receiving antiviral treatment,their accuracy in diagnosing liver fibrosis is still relatively good.