Diagnostic value of FIB-4, aspartate aminotransferaseto-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase

AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase(PNALT).METHODS We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase(PIALT1) group [alanine transaminase(ALT) within 1-2 × upper limit of normal value(ULN)], and 64 in PIALT2 group(ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were performed.RESULTS The pathological examination revealed moderate inflammatory necrosis ratios of 16.81%(16/95), 32.56%(28/86), and 45.31%(28/64), and moderate liverfibrosis of 24.2%(23/95), 33.72%(29/86), and 43.75%(28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group(P < 0.05). No significant difference was found in the areas under the curve(AUCs) between APRI and FIB-4 in the PNALT group; however, significant differences were found between APRI and LSM, and between FIB-4 and LSM in the PNALT group(P < 0.05 for both). In the PIALT1 and PIALT2 groups, no significant difference(P > 0.05) was found in AUCs for all comparisons(P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI(P < 0.05).CONCLUSION APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.

Use of aspartate aminotransferase to platelet ratio to reduce the need for Fibro Scan in the evaluation of liver fibrosis

To evaluate the performance of aspartate aminotransferase to platelet ratio (APRI) score against FibroScan in predicting the presence of fibrosis. METHODSData of patients who concurrently had APRI score, FibroScan and liver biopsy to assess their hepatitis C virus (HCV) and hepatitis B virus (HBV) over 6 years were retrospectively reviewed and details of their disease characteristics and demographics were recorded. Advanced fibrosis was defined as ≥ F3. RESULTSOf the 3619 patients (47.5 ± 11.3 years, 97M:36F) who had FibroScans and APRI for HCV and HBV, 133 had concurrent liver biopsy. Advanced liver fibrosis was found in 27/133 (20%, F3 = 21 and F4 = 6) patients. Although APRI score (P < 0.001, AUC = 0.83) and FibroScan (P < 0.001, AUC = 0.84) predicted the presence of advanced fibrosis, the sensitivities and specificities were only modest (APRI score: 51.9% sensitivity, 84.9% specificity; FibroScan: 63% sensitivity, 84% specificity). Whilst 13/27 (48%) patients with advanced fibrosis had APRI ≤ 1.0, no patients with APRI ≤ 0.5 had advanced fibrosis, with 100% sensitivity. The use of APRI ≤ 0.5 would avoid the need for FibroScan in 43% of patients. CONCLUSIONAPRI score and FibroScan performed equally well in predicting advanced fibrosis. A proposed APRI cut-off score of 0.5 could be used as a screening tool for FibroScan, as cut-off score of 1.0 will miss up to 48% of patients with advanced fibrosis. Further prospective validation studies are required to confirm this finding.

Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B

AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse(ARFI), aspartate aminotransferase to platelet ratio index(APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B(CHB). METHODS: In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated. RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage(all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI(P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage(Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI(Z = 0.958, P = 0.338). CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.

Noninvasive assessment of liver fibrosis with combined serum aminotransferase/platelet ratio index and hyaluronic acid in patients with chronic hepatitis B

AIM： To construct a noninvasive assessment model consisting of routine laboratory data to predict significant fibrosis and cirrhosis in patients with chronic hepatitis B （CHB）. METHODS： A total of 137 consecutive patients with CriB who underwent percutaneous liver biopsy were retrospectively analyzed. These patients were divided into two groups according to their aminotransferase （ALT） level. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）, the likelihood ratio （LR） of aminotransferase/platelet ratio index （APRI） ≥ 1.5 or 〈 1.5 in combination with different hyaluronic acid （HA） cut-off points were calculated for the presence of moderate to severe fibrosis/cirrhosis （fibrosis stages 2 and 4） and no to mild fibrosis/cirrhosis （fibrosis stages 0 and 1）. RESULTS： The APRI correlated with fibrosis stage in CriB patients. The APRI ≥1.5 in combination with a cut-off HA cut-off point 〉 300 ng/mL could detect moderate to severe fibrosis （stages 2-4） in Crib patients. The PPV was 93.7%, the specificity was 98.9%. The APRI 〈 1.5 in combination with different HA cut-off points could not detect no to mild fibrosis in CHB patients. CONCLUSION： The APRI ≥ 1.5 in combination with a HA cut-off point 〉 300 ng/mL can detect moderate to severe fibrosis （stages 2-4） in Crib patients.

Prediction of hepatocellular carcinoma development by aminotransferase to platelet ratio index in primary biliary cholangitis

AIM To investigate the usefulness of aspartate aminotransferase to platelet ratio index(APRI) in predicting hepatocellular carcinoma(HCC) risk in primary biliary cholangitis(PBC).METHODS We identified PBC patients between 2000 and 2015 by searching the electronic medical database of a tertiary center. The hazard ratio(HR) of HCC with different risk factors was determined by Cox proportional hazards model. RESULTS One hundred and forty-four PBC patients were recru-ited. Patients were diagnosed at a median age of 57.8 years [interquartile range(IQR): 48.7-71.5 years), and 41(28.5%) patients had cirrhosis at baseline. The median follow-up duration was 6.9 years(range: 1.0-26.3 years). Twelve patients developed HCC, with an incidence rate of 10.6 cases per 1000 patient-years. The overall 5-, 10-and 15-year cumulative incidences of HCC were 2.3% 95%CI: 0%-4.8%), 8.4%(95%CI: 1.8%-14.5%) and 21.6%(6.8%-34.1%), respectively. Older age(HR = 1.07), cirrhosis(HR = 4.38) and APRI at 1 year after treatment(APRI-r1) > 0.54(HR = 3.94) were independent factors for HCC development. APRI-r1, when combined with treatment response, further stratified HCC risk(log rank P < 0.05). The area under receiver operating curve of APRI-r1 in predicting HCC was 0.77(95%CI: 0.64-0.88).CONCLUSION APRI-r1 can be used to predict the development of HCC in PBC patients. Combination of APRI-r1 with treatment response can further stratify the HCC risk.

非酒精性脂肪性肝病患者C/RL-r、APRI、FIB-4水平与肝纤维化发生的相关性

目的分析非酒精性脂肪性肝病(NAFLD)患者改良肝尾状叶/右叶比值(C/RL-r)、天门冬氨酸氨基转移酶与血小板比值指数(APRI)、基于4因子的纤维化指数(FIB-4)与肝纤维化发生的相关性。方法选择2021年2月至2022年12月在保定市第一中心医院治疗的NAFLD患者153例,根据病理学结果,将患者分为无肝纤维化组81例、肝纤维化组72例。行MRI扫描检测C/RL-r;计算APRI、FIB-4水平;分析NAFLD患者实验室指标、C/RL-r、APRI、FIB-4水平与发生肝纤维化的相关性,发生肝纤维化的独立危险因素及C/RL-r、APRI、FIB-4对NAFLD患者发生肝纤维化的预测价值。结果肝纤维化组ALT、AST、TBil、GGT、TG、C/RL-r、APRI、FIB-4水平显著高于无肝纤维化组,分别为(42.32±10.21)U/L比(36.21±7.78)U/L、(45.36±8.72)U/L比(27.45±5.40)U/L、(13.52±3.65)μmol/L比(12.24±2.16)μmol/L、(60.53±13.41)U/L比(53.69±12.44)U/L、(1.99±0.53)mmol/L比(1.05±0.33)mmol/L、(1.15±0.12)比(0.92±0.09)、(0.52±0.15)比(0.32±0.10)、(1.47±0.47)比(0.94±0.30),高密度脂蛋白胆固醇(HDL-C)水平显著低于无肝纤维化组为(1.03±0.26)mmol/L比(1.32±0.45)mmol/L,(t=4.189、15.453、2.674、3.272、13.322、13.501、4.302、8.405、4.801,均P<0.05);NAFLD患者ALT、AST、TG、C/RL-r、APRI、FIB-4与发生肝纤维化呈正相关(r=0.531、0.435、0.571、0.605、0.771、0.716,均P<0.001);ALT、AST、TG、C/RL-r、APRI、FIB-4水平高是影响NAFLD患者发生肝纤维化的独立危险因素(P<0.05);C/RL-r、APRI、FIB-4、三者联合预测NAFLD患者发生肝纤维化的曲线下面积(AUC)分别为0.767、0.830、0.754、0.936;相较于C/RL-r、APRI、FIB-4单独预测的AUC,三者联合预测的AUC更高(Z=4.495、3.999、4.677,均P<0.001)。结论发生肝纤维化的NAFLD患者C/RL-r、APRI、FIB-4水平较高,三者联合检测对NAFLD患者发生肝纤维化具有较高预测价值。

基于天冬氨酸转氨酶-血小板计数比的列线图模型对肝细胞癌射频消融治疗后复发的预测价值

目的探讨天冬氨酸转氨酶-血小板计数比值指数(aspartate aminotransferase-platelet ratio index,APRI)与肝细胞癌(hepatocellular carcinoma,HCC)射频消融(radiofrequency ablation,RFA)治疗后肿瘤复发的关系。方法纳入2017年1月至2020年12月江苏大学附属武进医院初诊为HCC并接受RFA治疗的患者204例。采用受试者工作特征(receiver operation characteristics,ROC)曲线确定APRI的最佳截断值。绘制Kaplan-Meier曲线计算高、低APRI组患者的无复发生存期(recurrence-free survival,RFS)。Cox回归分析RFA后HCC复发的独立预测因素,并选择显著变量构建列线图模型。通过一致性指数(concordance index,C-index)和校正曲线评价列线图模型对HCC复发的预测能力。结果RFA治疗后HCC复发率为57.4%(117/204)。APRI预测HCC复发的最佳截断值为0.501,曲线下面积(area under curve,AUC)为0.678(95%CI:0.603~0.752)。高APRI组(≥0.501)121例,低APRI组(<0.501)83例,高APRI与患者低RFS显著相关(χ^(2)=12.929,P<0.01)。Cox回归分析证实,肿瘤数目(HR=1.541,95%CI:1.039~2.286,P=0.031)、肿瘤最大直径(HR=1.461,95%CI:1.011~2.112,P=0.044)、血清AFP(HR=2.286,95%CI:1.576~3.318,P<0.01)和APRI(HR=1.873,95%CI:1.257~2.790,P=0.002)是HCC复发的独立风险因素。基于以上4个因素构建预测RFA治疗后HCC复发的列线图模型,C-index为0.769(95%CI:0.676~0.862),预测1年、2年和3年RFS的AUC分别为0.707、0.719和0.707。校正曲线展示模型预测与实际复发风险之间具有良好一致性。结论基于APRI与肿瘤生物学特征的列线图模型对HCC复发具有良好预测能力。

脑出血患者循环血中HBP、ALT、AST、WBC、NEU、PLT表达与感染及预后的相关性

目的:讨论脑出血患者循环血中肝素结合蛋白(heparin-binding protein,HBP)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、白细胞(white blood cell,WBC)、中性粒细胞比率(neutrophil,NEU)、血小板(platelet,PLT)表达水平,分析其与患者感染及预后的关系。方法:选取脑出血患者164例,入院和出院时分别检测循环血中HBP、ALT、AST、WBC、NEU和PLT水平,分组分析以上指标与感染和预后的相关性。结果:感染组HBP、WBC、NEU、PLT最高值水平均高于非感染组。感染组患者预后比较ALT和WBC最高值、非感染组患者预后比较NEU最高值,差异有统计学意义(P<0.05)。AST最高值是否异常在不同预后情况中比例相反。ROC曲线分析显示,HBP、ALT、AST、WBC最高值联合检测对脑出血患者预后不良的曲线下面积为0.781,敏感度和特异度分别为85.7%和62.7%。结论:脑出血患者循环血中HBP、WBC、NEU及PLT在检测中最高值异常高表达提示感染风险,当HBP、ALT、AST、WBC水平联合检测对脑出血患者预后不良具有较好的预测效能。

无创模型评估慢乙肝肝纤维化的临床价值

目的探究无创模型评估慢乙肝肝纤维化程度的临床使用价值。方法收集经肝穿诊断为肝纤维化的92例慢乙肝患者资料,根据肝纤维化程度将患者分为轻度肝纤维化组和显著肝纤维化组,采用全自动生化分析仪检测2组患者静脉血天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT),血细胞分析仪检测2组患者静脉血血小板计数(PLT)及红细胞分布宽度(RDW),计算AST与ALT比值(AAR)、AST与PLT比值(APRI)、RDW与PLT比值(RPR)及4因子肝纤维化指数(FIB-4);应用受试者工作特征曲线(ROC)曲线下面积(AUC)评价上述无创模型对肝纤维化的诊断价值。结果轻度纤维化组血清ALT与AST、APRI、RPR以及FIB-4均低于显著纤维化组(P<0.05),PLT和AAR则高于显著纤维化组(P<0.05);应用AAR、APRI、RPR和FIB-4评估慢性乙型肝炎肝纤维化程度的AUC分别为0.406、0.711、0.729和0.692;4项指标联合诊断的AUC为0.741,显著高于4项中的任何1项单独指标(P<0.05)。结论APRI、RPR和FIB-4是诊断慢乙肝患者肝纤维化程度的有效指标,4种模型联合应用可提高乙肝肝纤维化程度诊断和预测的准确性。

TBil、APRI联合GGT/Alb比值对胆道闭锁患儿肝纤维化严重程度的诊断价值

目的:探讨总胆红素(TBil)、天冬氨酸氨基转移酶/血小板比值指数(APRI)联合γ-谷氨酰转肽酶(GGT)/白蛋白(Alb)比值在诊断胆道闭锁(BA)患儿肝纤维化严重程度中的价值。方法:选取2021年9月至2023年9月于郑州大学附属儿童医院确诊且住院手术的BA患儿120例为研究对象,依据肝纤维化严重程度分为<F2期组和≥F2期组,记录患儿一般资料及临床指标。结果:≥F2期组患儿TBil、APRI、GGT/Alb比值、天冬氨酸氨基转移酶(AST)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-Col)、透明质酸(HA)、层黏蛋白(LN)显著高于<F2期组患儿(P<0.05)。BA患儿TBil、APRI、GGT/Alb比值与AST、PCⅢ、Ⅳ-Col、HA、LN均呈正相关(P<0.05)。TBil、APRI、GGT/Alb比值是BA患儿发生明显肝纤维化的独立危险因素(OR=2.939、2.873、2.895,P<0.05)。TBil、APRI、GGT/Alb比值单独及联合诊断的曲线下面积分别为0.837、0.841、0.851、0.956。结论:TBil、APRI、GGT/Alb比值联合在诊断BA患儿肝纤维化程度方面具有重要价值。

天冬氨酸氨基转移酶与血小板比值指数与纤维化-4指数对肝癌切除术后患者预后的预测价值

目的探讨肝硬化血液生化指标天冬氨酸氨基转移酶与血小板比值指数(APRI)、纤维化-4指数(FIB-4)对肝癌切除术后患者预后的预测价值。方法回顾性收集2005年2月至2017年7月在复旦大学附属中山医院行肝癌根治性切除300例患者的临床病理资料、肝癌复发和生存情况,分析APRI、FIB-4与肝癌患者术后复发、生存的关系,应用ROC曲线评价APRI、FIB-4对肝癌切除术后患者预后的预测价值。结果300例患者的中位随访时间为61个月。单因素Cox回归分析显示,APRI、FIB-4、血管侵犯是影响肝癌患者术后无复发生存期(DFS)、总生存期(OS)的危险因素;多因素Cox回归分析显示,血管侵犯是影响肝癌患者术后DFS(HR=1.518,95%CI 1.024~2.252,P=0.038)、OS(HR=2.301,95%CI 1.270~4.167,P=0.006)的独立危险因素。时间依赖ROC(time-ROC)结果显示,APRI、FIB-4预测术后1年、3年和5年DFS的曲线下面积(AUC)为0.555~0.596,预测术后1年、3年和5年OS的AUC为0.600~0.679。结论基于血液生化检测的肝硬化指标APRI与FIB-4对肝癌患者术后预后的预测价值有限。

APRI评分与妊娠期肝内胆汁淤积症的相关性研究

目的探究天冬氨酸转氨酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)与妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的相关性。方法选取安徽医科大学附属巢湖医院产科于2021年9月至2023年3月收治的70例ICP孕妇作为病例组,选择同期70名健康孕妇作为对照组。采用回顾性研究方法,收集并分析两组孕妇分娩前1周的一般资料及实验室资料,并用t检验进行两组间的比较。运用Pearson相关系数法分析APRI与总胆汁酸(total bile acid,TBA)相关性;Logistic回归分析APRI与ICP的关系,采用受试者操作特征(receiver operating characteristic,ROC)曲线评估APRI在ICP中的应用价值。结果ICP组的APRI(1.1±1.2)高于对照组(0.2±0.1),差异有统计学意义(P<0.05)。重度ICP组的APRI(1.9±2.2)与轻度ICP组(0.9±0.7)比较,差异无统计学意义(P>0.05)。在ICP组中,APRI与TBA呈正相关(r=0.657,P<0.05)。Logistic回归分析结果表明,APRI不是ICP发生的独立影响因素(P>0.05)。APRI的曲线下面积(area under the curve,AUC)为0.870(P<0.05)。结论APRI与ICP的发生及其发展有一定的相关性,而对ICP的病情评估未显示出确定价值。

肝硬化伴上消化道出血患者外周血APRI的表达水平及临床意义

目的 探讨肝硬化并发上消化道出血患者外周血天门冬氨酸氨基转移酶(AST)和外周血血小板(PLT)比率指数(APRI)的表达水平及临床意义。方法 选取该院在2018年12月至2021年11月收治的肝硬化患者89例作为研究对象,按照是否并发上消化道出血分为出血组(44例)和非出血组(45例)。检测并比较两组患者外周血凝血酶原时间(PT)、纤维蛋白原(FIB)、清蛋白-胆红素(ALBI)及APRI水平,绘制受试者工作特征(ROC)曲线分析APRI及FIB对肝硬化患者并发上消化道出血的预测价值。比较出血组不同临床资料患者的外周血APRI表达水平。结果 出血组外周血APRI表达水平高于非出血组,而FIB水平低于非出血组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,APRI预测肝硬化患者并发上消化道出血的曲线下面积(AUC)为0.714,灵敏度和特异度分别为71.1%和75.0%。出血组肝功能不同Child-Pugh分级患者APRI表达水平表现为A级患者<B级患者<C级患者,差异均有统计学意义(P<0.05);出血组的APRI表达水平表现为重度患者>中度患者>轻度患者,差异均有统计学意义(P<0.05);出血组6个月内死亡患者的APRI表达水平高于存活患者(P<0.05)。结论 肝硬化并发上消化道出血患者的外周血APRI表达水平明显升高,具有一定的预测价值,且外周血APRI表达水平与病情严重程度及预后有关,是潜在的疾病标志物。

Predictive model for non-malignant portal vein thrombosis associated with cirrhosis based on inflammatory biomarkers

BACKGROUND Portal vein thrombosis(PVT),a complication of liver cirrhosis,is a major public health concern.PVT prediction is the most effective method for PVT diagnosis and treatment.AIM To develop and validate a nomogram and network calculator based on clinical indicators to predict PVT in patients with cirrhosis.METHODS Patients with cirrhosis hospitalized between January 2016 and December 2021 at the First Hospital of Lanzhou University were screened and 643 patients with cirrhosis who met the eligibility criteria were retrieved.Following a 1:1 propensity score matching 572 patients with cirrhosis were screened,and relevant clinical data were collected.PVT risk factors were identified using the least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression analysis.Variance inflation factors and correlation matrix plots were used to analyze multicollinearity among the variables.A nomogram was constructed to predict the probability of PVT based on independent risk factors for PVT,and its predictive performance was verified using a receiver operating characteristic curve(ROC),calibration curves,and decision curve analysis(DCA).Finally,a network calculator was constructed based on the nomograms.RESULTS This study enrolled 286 cirrhosis patients with PVT and 286 without PVT.LASSO analysis revealed 13 variables as strongly associated with PVT occurrence.Multivariate logistic regression analysis revealed nine indicators as independent PVT risk factors,including etiology,ascites,gastroesophageal varices,platelet count,D-dimer,portal vein diameter,portal vein velocity,aspartate transaminase to neutrophil ratio index,and platelet-to-lymphocyte ratio.LASSO and correlation matrix plot results revealed no significant multicollinearity or correlation among the variables.A nomogram was constructed based on the screened independent risk factors.The nomogram had excellent predictive performance,with an area under the ROC curve of 0.821 and 0.829 in the training and testing groups,respectively.Calibration curves and DCA revealed its good clinical performance.Finally,the optimal cutoff value for the total nomogram score was 0.513.The sensitivity and specificity of the optimal cutoff values were 0.822 and 0.706,respectively.CONCLUSION A nomogram for predicting PVT occurrence was successfully developed and validated,and a network calculator was constructed.This can enable clinicians to rapidly and easily identify high PVT risk groups.

Improvement of hepatic fibrosis after tenofovir disoproxil fumarate switching to tenofovir alafenamide for three years

BACKGROUND Both tenofovir alafenamide(TAF)and tenofovir disoproxil fumarate(TDF)are the first-line treatments for chronic hepatitis B(CHB).We have showed switching from TDF to TAF for 96 weeks resulted in further alanine aminotransferase(ALT)improvement,but data remain lacking on the long-term benefits of TDF switching to TAF on hepatic fibrosis.AIM To assess the benefits of TDF switching to TAF for 3 years on ALT,aspartate aminotransferase(AST),and hepatic fibrosis improvement in patients with CHB.METHODS A single center retrospective study on 53 patients with CHB who were initially treated with TDF,then switched to TAF to determine dynamic patterns of ALT,AST,AST to platelet ratio index(APRI),fibrosis-4(FIB-4)scores,and shear wave elastography(SWE)reading improvement at switching week 144,and the associated factors.RESULTS The mean age was 55(28-80);45.3%,males;15.1%,clinical cirrhosis;mean baseline ALT,24.8;AST,25.7 U/L;APRI,0.37;and FIB-4,1.66.After 144 weeks TDF switching to TAF,mean ALT and AST were reduced to 19.7 and 21,respectively.From baseline to switching week 144,the rates of ALT and AST<35(male)/25(female)and<30(male)/19(female)were persistently increased;hepatic fibrosis was also improved by APRI<0.5,from 79.2%to 96.2%;FIB-4<1.45,from 52.8%to 58.5%,respectively;mean APRI was reduced to 0.27;FIB-4,to 1.38;and mean SWE reading,from 7.05 to 6.30 kPa after a mean of 109 weeks switching.The renal function was stable and the frequency of patients with glomerular filtration rate>60 mL/min was increased from 86.5%at baseline to 88.2%at switching week 144.CONCLUSION Our data confirmed that switching from TDF to TAF for 3 years results in not only persistent ALT/AST improvement,but also hepatic fibrosis improvement by APRI,FIB-4 scores,as well as SWE reading,the important clinical benefits of long-term hepatitis B virus antiviral treatment with TAF.

AST/PLT比值指数与乙肝肝硬化抗病毒治疗患者肝癌发生的关系

目的分析谷草转氨酶(AST)/血小板计数(PLT)比值指数与乙肝肝硬化抗病毒治疗患者肝癌发生的关系。方法回顾性分析,收集确诊后接受抗病毒治疗和2年随访的103例乙肝肝硬化患者资料,患者人口学资料、治疗相关资料、实验室指标检查结果等资料均保存完整。仔细查阅患者资料,记录其随访期间肝癌发生情况,将发生纳入肝癌组,未发生纳入非肝癌组,记录患者人口学资料与临床资料。记录并比较两组患者抗病毒治疗前的AST、PLT水平,计算AST/PLT比值指数。经Logistic回归分析检验AST、PLT水平及AST/PLT比值与乙肝肝硬化抗病毒治疗患者肝癌发生的关系。结果103例患者在2年随访期间,共发生肝癌26例,发生率为25.24%(26/103)。肝癌组与非肝癌组性别、年龄、体质量指数、饮酒史及病理类型等资料比较均无统计学差异(P>0.05)。肝癌组AST水平、AST/PLT比值指数高于非肝癌组,PLT水平低于非肝癌组,差异有统计学意义(P<0.05);经回归分析检验结果显示,AST、PLT水平及AST/PLT比值与乙肝肝硬化抗病毒治疗患者肝癌的发生有关,是肝癌发生的影响因素(P<0.05),其中AST/PLT比值可作为独立风险因子。结论AST/PLT比值指数与乙肝肝硬化抗病毒治疗患者肝癌发生有关,是患者肝癌发生的独立风险因子,应引起临床重视。

肝纤维化指标、外周血常规指标和GPR对重度慢性乙型 肝炎的诊断价值及其相关性分析

目的评价肝纤维化指标[透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原氨基端肽(PⅢNP)和Ⅳ型胶原(ⅣC)]、外周血常规指标[包括红细胞体积分布宽度(RDW)、白细胞计数(WBC)、淋巴细胞计数(LY)、平均血小板体积(MPV)和血小板计数(PLT)]、γ-谷氨酰转移酶(GGT)与PLT比值(GPR)对重度慢性乙型肝炎的诊断价值及其相关性。方法选取2022年1月至2023年6月该院收治的120例重度慢性乙型肝炎患者作为观察组,根据Child-Pugh肝功能分级分为A、B、C级,另选取同期100例健康体检者作为对照组。采集两组清晨空腹静脉血5 mL,采用放射免疫法检测肝纤维化指标,采用全自动血细胞分析仪以速率法检测外周血常规指标,采用全自动生化分析仪以速率法检测GGT,并计算GPR。绘制受试者工作特征(ROC)曲线,统计曲线下面积(AUC),评估肝纤维化指标、外周血常规指标、GPR对重度慢性乙型肝炎的诊断价值,并对各项指标进行相关性分析。结果观察组HA、LN、PⅢNP和ⅣC水平均明显高于对照组,且肝功能越差HA、LN、PⅢNP和ⅣC水平越高,A级<B级<C级,差异均有统计学意义(P<0.05);观察组WBC和PLT均低于对照组,且A、B级PLT均高于C级,差异均有统计学意义(P<0.05),观察组RDW、MPV和GPR均高于对照组,且A级<B级<C级,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,肝纤维化指标、外周血常规指标、GPR诊断重度慢性乙型肝炎的灵敏度、特异度均较高,AUC分别为0.985、0.892、0.773。WBC、LY、PLT与肝纤维化指标均呈负相关(P<0.05),RDW、MPV与肝纤维化指标均呈正相关(P<0.05);GPR与肝纤维化指标均呈正相关(P<0.05);WBC、LY、PLT与GPR均呈负相关(P<0.05),RDW、MPV与GPR均呈正相关(P<0.05)。结论肝纤维化指标、外周血常规指标、GPR对重度慢性乙型肝炎均有较高的诊断价值,WBC、RDW、LY、MPV、PLT和GPR的变化可用来判断慢性乙型肝炎的肝纤维化程度。

超声弹性成像组织弥散定量分析与综合评分对慢性肝炎肝纤维化的诊断价值研究

背景肝纤维化是慢性肝病发展为肝硬化的可逆中间环节,早期诊断和及时干预对延缓疾病进展及改善预后极为重要。目的通过分析超声弹性成像组织弥散定量分析和天冬氨酸氨基转移酶(AST)与血小板计数(PLT)比值指数(APRI)、综合评分对慢性病毒性肝炎肝纤维化的诊断价值,为无创诊断肝纤维化提供临床依据。方法选取2012年2月—2013年12月在广东省人民医院感染科住院治疗的慢性乙型肝炎患者158例,其中F1期38例(F1期组)、F2期53例(F2期组)、F3期38例(F3期组)、F4期29例(F4期组),另选取同期本院体检的健康志愿者38例为对照组,检测AST、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)、总胆红素、PLT等血清学指标,记录超声弹性成像组织弥散定量评分(ES),根据公式计算APRI及综合评分。分析APRI及综合评分诊断肝纤维化分期的ROC曲线下面积,综合评分截断值及灵敏度、特异度。结果对照组与不同肝纤维化分期组患者AST、ALT、GGT、总胆红素及PLT水平比较,差异均有统计学意义(P<0.05)。F1期组、F2期组、F3期组、F4期组患者超声弹性成像组织弥散定量分析检测感兴趣区(ROI)的应变均值、标准偏差、蓝色区域(AREA)、复杂度比较,差异均有统计学意义(P<0.05);组间两两比较,差异均有统计学意义(P<0.05)。Spearman等级相关分析结果显示,APRI、ES、综合评分与肝纤维化分期均呈正相关(rs=0.646,P<0.001;rs=0.739,P<0.001;rs=0.830,P<0.001)。APRI诊断≥F2期、≥F3期和≥F4期肝纤维化的ROC曲线下面积分别为0.86、0.88、0.89;综合评分诊断≥F2期、≥F3期和≥F4期肝纤维化的ROC曲线下面积分别为0.93、0.95、0.92。综合评分截断值为100分时,诊断≥F2期肝纤维化的灵敏度为84.6%、特异度为88.2%;综合评分截断值为100分时,诊断≥F3期肝纤维化的灵敏度为91.5%、特异度为81.3%;综合评分截断值为114分时,诊断≥F4期肝纤维化的灵敏度为48.2%、特异度为100.0%。结论超声弹性成像组织弥散定量分析可较好地用于慢性病毒性肝炎肝纤维化的诊断,并且结合血清学指标的综合评分能够更好地提高诊断准确度。

扶正化瘀胶囊联合核苷类抗病毒药物对HBV感染失代偿期肝硬化患者肝肾功能、血清炎性因子、TLR-4、TGF-β1及谷草转氨酶-血小板比值指数的影响

目的:探讨扶正化瘀胶囊联合核苷类抗病毒药物对HBV感染失代偿期肝硬化患者肝肾功能、血清炎性因子、Toll样受体4(TLR-4)、转化生长因子β1(TGF-β1)及谷草转氨酶-血小板比值指数(APRI)的影响。方法:选取HBV感染失代偿期肝硬化患者144例。随机分为对照组和病例组,每组各72例。对照组给予恩替卡韦口服;病例组予恩替卡韦和扶正化瘀。观察2组患者的肝肾功能、血清炎性因子、TLR-4、TGF-β1及APRI的变化。结果:病例组总有效率高于对照组,差异有统计学意义(P<0.05)。病例组HBV DNA转阴率、HBsAg转阴率、HBeAg转阴率明显高于对照组;治疗后ALT、AST、TBIL、HA、LN、PCⅢ、CIV、门静脉内径、脾静脉内径、脾脏厚度、阻力指数、BUN、Cr、IL-6、IL-8、hs-CRP、TNF-α、TLR-4、TGF-β1、APRI较治疗前降低,ALB和肾血流量较治疗前升高;病例组肝功能指标、肝纤维化指标、肝脾影像学指标、肾脏血流动力学指标、血清炎性因子、TLR-4、TGF-β1、APRI改善程度明显优于对照组,差异均有统计学意义(P<0.05)。结论:扶正化瘀胶囊联合核苷类抗病毒药物对HBV感染失代偿期肝硬化患者临床疗效确切,并能有效抑制HBV复制,改善肝肾功能,减轻炎性因子。

声触诊组织量化联合谷草转氨酶/血小板比值对慢性乙型病毒性肝炎患者肝纤维化分期的价值

目的探讨采用声触诊组织量化（VTQ）技术联合谷草转氨酶/血小板比值（APRI）对慢性乙型病毒性肝炎患者肝纤维化分期的价值。方法将117例慢性乙型病毒性肝炎患者按照穿刺活检病理结果,分为F1-F4组,均接受VTQ检查,测量并计算肝脏右叶s5-s8段的剪切波速度作为VTQ值,同时计算每例患者的APRI。随机选择34名健康志愿者作为对照组（F0组）,同法测量、记录所有指标。分析VTQ、APRI与病理学分期的相关性,采用ROC曲线评价VTQ、APRI及二者线性结合（VTQ＋APRI）分期F2以上级别肝纤维化的效能。结果各组VTQ值比较,除F1与F2组间差异无统计学意义（P〉0.05）外,其余各组两两比较差异有统计学意义（P〈0.05）;APRI除F0与F1组间差异无统计学意义（P〉0.05）,其余各组间比较均差异有统计学意义（P〈0.05）。患者VTQ和APRI与肝纤维化病理学分期均呈正相关（r=0.814,0.677,P〈0.001）。评价≥F2级肝纤维化时,VTQ比APRI显示出更好的特异度（89.83%vs71.19%）,阳性预测值（92.11%vs 82.47%）,阳性似然比（7.48vs 3.02）,ROC曲线下面积（AUC）亦较大（0.898vs0.845）;而VTQ＋APRI的AUC、敏感度、阴性预测值分别为0.913、82.61%、76.47%,均高于单独应用VTQ（0.898、76.09%、70.67%）。结论 VTQ与APRI均与慢性乙型病毒性肝炎患者肝纤维化程度相关。对于F2以上级别肝纤维化,VTQ的诊断准确性高于APRI,而二者结合的诊断效能更高。