APRI联合FIB-4指数对慢性乙型肝炎患者肝硬化的诊断价值评估

Evaluation of APRI combined with FIB-4 index for diagnosing liver cirrhosis in patients with chronic hepatitis B

目的 探讨天冬氨酸转氨酶/血小板比值指数(APRI)联合年龄-天冬氨酸转氨酶-血小板-丙氨酸氨基转移酶相关比值(FIB-4)指数对乙型肝炎e抗原(HBeAg)阳性/阴性慢性乙型肝炎(CHB)患者肝硬化的诊断价值。方法 收集2019年2月—2022年12月淮安市第四人民医院初治CHB患者768例。经筛选后纳入507例,其中HBeAg阳性71例,HBeAg阴性436例,肝硬化患者88例。患者入组时记录临床资料、肝穿刺病理资料和常规实验室指标。根据公式计算APRI与FIB-4指数,分析其与肝硬化的相关性。应用受试者工作特征(ROC)曲线比较APRI、FIB-4及联合指标对HBeAg阳性/阴性CHB相关肝硬化的诊断价值,利用单因素与多因素logistic回归分析肝硬化的独立危险因素。结果 入选的CHB患者男女比例为343∶164,HBeAg阴性患者年龄更大,HBeAg阳性患者的肝硬化比例更高。APRI为HBeAg阳性/阴性肝硬化的独立危险因素,FIB-4指数为HBeAg阴性肝硬化的独立危险因素。FIB-4的ROC曲线下面积(AUC)均小于APRI。APRI和FIB-4联合检测在HBeAg阳性和阴性患者的AUC分别为0.79和0.69,因此APRI和FIB-4的联合检测对肝硬化的诊断效果更好。APRI、FIB-4诊断HBeAg阳性和阴性CHB肝硬化患者的最佳截断值分别为0.53和0.47、1.53和1.59。结论 APRI联合FIB-4指数可作为CHB相关肝硬化的诊断指标。

Objective To investigate the diagnostic value of aspartate transaminase(AST)to platelet(PLT)ratio index(APRI)combined with age-AST-PLT-alanine aminotransferase(ALT)related ratio fibrosis-4(FIB-4)index for liver cirrhosis in patients with hepatitis B e antigen(HBeAg)positive and negative chronic hepatitis B(CHB).Methods A total of 768 CHB patients who were first treated in Huai′an No.4 People′s Hospital from February 2019 to December 2022 were selected.After screening,507 patients were enrolled,including 71 HBeAg positive patients,436 HBeAg negative patients and 88 liver cirrhosis patients.Their clinical data,pathological data of liver puncture and routine laboratory indexes were recorded when the patients were enrolled.APRI and FIB-4 indexes were calculated according to the formula,and their correlation with liver cirrhosis was analyzed.A receiver operating characteristic(ROC)curve was plotted to compare the diagnostic value of APRI,FIB-4 and combined indexes for HBeAg positive/negative CHB-related liver cirrhosis.Univariate and multivariate logistic regression analysis were performed to determine the independent risk factors of liver cirrhosis.Results The male to female ratio of enrolled CHB patients was 343∶164,and HBeAg negative patients were older,but the proportion of liver cirrhosis was higher in HBeAg-positive patients.APRI was an independent risk factor for HBeAg-positive/negative cirrhosis,and FIB-4 for HBeAg-negative cirrhosis.The area under the ROC curve(AUC)of FIB-4 was less than the APRI.The AUC values of combined APRI and FIB-4 in the HBeAg positive/ negative group were 0. 79 and 0. 69, respectively. Therefore, the combination of APRI and Fib-4 was more effective in the diagnosis of liver cirrhosis. The optimal cut-off values of APRI and FIB-4 for diagnosis ofliver cirrhosis in HBeAg positive and HBeAg negative patients were 0. 53 and 0. 47, and 1. 53 and 1. 59, respectively.Conclusions APRI combined with FIB-4 index can be used as a useful diagnostic indicator for liver cirrhosis in CHBpatients.