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.

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.

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.

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.

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.

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。

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。

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.

APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化的早期预警价值

目的探讨APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化的早期预警价值。方法回顾性分析确诊为慢性乙型肝炎的患者402例,根据肝活组织检查结果分组:无明显肝纤维化组(S_0-S_1)146例,明显肝纤维化组(S_2-S_3)162例、早期肝硬化组(S_4)94例。每例患者进行APRI、FIB-4及Fibro Touch的评估。计算上述无创指标联合检测与肝组织病理的相关性,分析无创诊断模型对乙肝患者肝纤维化(≥S_2)的早期诊断价值,同时绘制受试者工作特征(ROC)曲线,计算最佳预测值、灵敏度及特异性。结果 APRI、FIB-4及Fibro Touch 3种无创诊断方法与肝活组织检查具有良好一致性(P<0.05),其Spearman相关系数分别为0.768、0.712、0.865。根据肝组织病理结果将入组病例分为无明显肝纤维化组(S_0-S_1)与肝纤维化组(≥S_2),对无创诊断模型行多因素二元Logistic回归分析提示APRI、FIB-4及Fibro Touch对肝纤维化均有一定的预测价值(P<0.05),其OR值分别为1.996、1.563及2.180。以APRI、FIB-4、Fibro Touch作为参数拟合Logistic二元回归方程,拟合优度高(χ~2=13.689,P=0.126),得出上述指标联合检测对肝纤维化早期预警方程为logit(P)=-0.556+1.119*(APRI)+1.202*(FIB-4)+1.682*(Fibro Touch)。ROC曲线分析显示3种方法联合检测对于肝纤维化(≥S_2)的早期预警价值最大,Fibro Touch检测预警效能优于APRI、FIB-4,而APRI和FIB-4在肝纤维化的早期预警价值无显著差异。采用上述指标联合对于肝纤维化(≥S_2)的早期预警曲线下面积为0.928,其最大约登指数为0.819,最佳临界值为18.14,对应的灵敏度、特异度分别为89.6%和92.3%。结论 APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化具有较高的早期预警价值,值得推广。

aMAP、APRI、FIB-4及肝硬度评估乙型肝炎肝硬化患者食管胃静脉曲张程度的价值探讨

目的:探讨aMAP(age-male-ALBI-platelet,aMAP)、天门冬氨酸氨基转移酶/血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)、基于4因子的肝纤维化指数(fibrosis index based on the 4 factors,FIB-4)及肝硬度值(liver stiffness measurement,LSM)评估乙型肝炎(乙肝)肝硬化患者食管胃静脉曲张(esophageal gastric varices,EGV)程度的价值。方法:选取2018年4月到2022年5月期间在上海交通大学医学院附属瑞金医院确诊并接受治疗的乙肝肝硬化患者114例,对其进行肝功能、血常规、LSM、胃镜等检查,根据计算公式计算aMAP、APRI、FIB-4。根据胃镜结果将患者分为无EGV组(39例)、轻度EGV组(30例)、中度EGV组(23例)及重度EGV组(22例),比较4组间的aMAP、APRI、FIB-4。采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析aMAP、APRI、FIB-4及LSM评估乙肝肝硬化患者EGV程度的价值。结果:EGV患者(包括轻度、中度及重度EGV组)的aMAP、APRI、FIB-4、LSM均显著高于无EGV的患者,差异有统计学意义(P<0.05)。轻度、中度及重度EGV组间的aMAP、APRI、FIB-4差异均有统计学意义(P<0.05);轻度EGV组与中度、重度EGV组间LSM差异有统计学意义(P<0.05)。aMAP评估EGV程度的ROC曲线下面积(the area under ROC curve,AUROC)为0.76,灵敏度为85.9%,特异度为65.7%;APRI、FIB-4和LSM评估EGV程度的AUROC分别为0.86、0.85、0.79,灵敏度分别为81.30%、82.80%、88.40%,特异度分别为82.90%、77.10%、66.80%。aMAP、APRI、FIB-4和LSM对肝硬化患者是否合并EGV有较好诊断价值(P<0.05)。aMAP、APRI、FIB-4对乙肝肝硬化患者的EGV程度有一定诊断价值(P<0.05),但特异度较低。结论:aMAP、APRI、FIB-4及LSM诊断乙肝肝硬化患者伴EGV的价值较高,而aMAP、APRI及FIB-4对其EGV程度有一定评估价值,可作为不适合做胃镜患者评估EGV的补充参考,为EGV的预防及治疗提供依据。

瞬时弹性成像联合APRI诊断自身免疫性肝炎患者肝纤维化效能研究

目的探讨应用天冬氨酸氨基转移酶/血小板计数比值(APRI)联合瞬时弹性成像行肝硬度检测(LSM)诊断自身免疫性肝炎(AIH)患者肝纤维化的效能。方法2019年8月~2022年8月我院诊治的AIH患者67例和同期健康体检者54例。AIH患者接受肝活检,所有受试者接受FibroScan肝脏弹性成像和血液检测,获得LSM和APRI。绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估参数诊断显著性肝纤维化的效能。结果AIH组血清AST水平为(104.3±21.9)U/L,显著高于对照组【(30.5±5.1)U/L,P<0.05】,APRI和LSM分别为(1.4±0.1)和(8.1±1.2)kPa,显著大于对照组【分别为(0.4±0.1)和(4.3±0.7)kPa,P<0.05】,而外周血PLT计数为(157.8±23.1)×10^(9)/L,显著低于对照组【(208.5±20.7)×10^(9)/L,P<0.05】;肝组织病理学检查显示,67例AIH患者存在肝纤维化S0期10例、S1期17例、S2期19例、S3期13例和S4期8例;S4期患者APRI和LSM分别为(2.1±0.3)和(13.9±2.8)kPa,S3期分别为(1.8±0.2)和(11.2±2.1)kPa,S2期分别为(1.5±0.2)和(7.6±1.5)kPa,均显著高于S1期【分别为(1.1±0.2)和(6.1±1.2)kPa,P<0.05】或S0期【分别为(0.8±0.1)和(4.0±0.5)kPa,P<0.05】;经ROC分析显示,分别以APRI=1.5和LSM=7.5 kPa为截断点,两者联合诊断显著性肝纤维化的AUC为0.950,其敏感度和特异度分别为95.0%和85.2%,显著优于APRI(其敏感度和特异度分别为90.0%和81.5%)或LSM(其敏感度和特异度分别为75.0%和96.3%)诊断。结论应用LSM联合APRI诊断AIH患者显著性肝纤维化具有较高的临床应用价值,或可用于初筛检查。

肝瞬时弹性成像指标、脾脏厚度、门静脉内径及FIB4、APRI与肝硬化食管静脉曲张程度的相关性

目的:探究肝瞬时弹性成像指标、脾脏厚度、门静脉内径及纤维化-4指数(FIB4)、天门冬酸氨基转移酶与血小板比率指数(APRI)与肝硬化食管静脉曲张程度的相关性。方法:选取2020年12月—2022年2月天津市第二人民医院收治的40例肝硬化重度食管静脉曲张患者为A组,40例肝硬化中度食管静脉曲张患者为B组,40例肝硬化轻度食管静脉曲张患者为C组,40例肝硬化无食管静脉曲张患者为D组。四组均进行肝瞬时弹性成像检测、丙氨酸氨基转移酶(ALT)、天门冬酸氨基转移酶(AST)及血小板(PLT)检测,并计算FIB4及APRI。比较四组肝瞬时弹性成像指标、脾脏厚度、门静脉内径及FIB4、APRI,采用Spearman秩相关分析上述检测指标与肝硬化食管静脉曲张严重程度的关系。结果:A组、B组及C组的肝硬度值、脾硬度值、脾脏厚度及门静脉内径、FIB4及APRI均显著高于D组,A组与B组肝硬度值、脾硬度值、脾脏厚度及门静脉内径、FIB4及APRI均显著高于C组,A组肝硬度值、脾硬度值、脾脏厚度及门静脉内径、FIB4及APRI均著高于B组,差异有统计学意义(P<0.05)。Spearman秩相关分析结果显示,肝硬度值、脾硬度值、脾脏厚度、门静脉内径及FIB4、APRI均与肝硬化食管静脉曲张程度呈正相关(P<0.05)。结论:肝硬化食管静脉曲张患者的肝瞬时弹性成像指标、脾脏厚度、门静脉内径及FIB4、APRI表达显著异常,且上述指标与食管静脉曲张的程度密切相关,因此其在肝硬化食管静脉曲张患者中的检测价值较高。

APRI评分对HBV相关肝细胞癌切除术患者预后的预测价值

目的:评估天冬氨酸转氨酶与血小板计数比值指数(APRI)对HBV相关肝细胞癌(HCC)切除术患者术后总生存率(OS)的预测价值。方法:采用回顾性队列研究方法,收集2012年1月至2016年12月期间在广西医科大学附属肿瘤医院行切除术治疗的1 031例HBV相关HCC患者的术前临床资料。通过Kaplan-Meier生存曲线确定APRI评分的cutoff值。采用Kaplan-Meier法绘制不同APRI组患者的生存曲线,并通过Log-rank检验评估两组人群的生存差异。运用逐步多因素Cox回归筛选患者OS独立影响因素。采用限制性立方条图(RCS)评价患者APRI与死亡风险的相关性。建立列线图模型评估APRI对OS的预测能力并内部验证。结果:RCS显示APRI与死亡风险呈非线性关联(非线性P<0.001)。多因素Cox回归结果显示:APRI、BCLC分期、AFP、性别和肿瘤大小是OS独立影响因素,高APRI组死亡风险是低APRI组2.1倍。患者OS的列线图显示APRI对OS的预测能力仅次于BCLC分期。在建模组和验证组中预测OS列线图的C-in-dex分别为0.71(95%CI:0.68~0.74)、0.69(95%CI:0.64~0.75);1和5年OS校正曲线显示列线图具有良好的校准度;临床决策曲线(DCA)显示模型具有良好的临床应用价值。结论:APRI是HBV相关HCC切除术患者OS独立影响因素,基于APRI对患者预后进行分层,有利于进行个体化治疗和随访。

FibroScan联合GPR、APRI和FIB-4诊断血清ALT正常的慢性HBV感染者肝纤维化价值分析

目的 评价基于4因子的肝纤维化指数(FIB-4)、γ-谷氨酰转肽酶/血小板比值(GPR)、天冬氨酸氨基转移酶/血小板比值(APRI)和FibroScan诊断HBV感染者肝纤维化的价值。方法 2015年2月~2020年12月广东省中医院肝病科诊治的血清ALT正常的慢性HBV感染者154例,纳入人群血清HBV DNA阳性,均接受肝活检,采用Scheuer评分系统评价肝纤维化程度。常规检测血小板计数和血生化指标,计算FIB、APRI和GPR指数,使用FibroScan-502诊断仪行肝硬度检测LSM(kPa)。采用多因素二元Logistic回归分析构建联合预测模型,绘制受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC),采用Delong法对AUC进行两两比较。结果 肝组织病理学检查显示,S0 34例,S1 47例,S2 48例,S3 22例,S4 3例,其中73例(47.4%)存在显著性肝纤维化(≥S2),25例(16.2%)存在进展性肝纤维化;≥S2患者FIB-4、APRI、GPR和LSM分别为1.0(0.8,1.2)、0.3(0.2,0.4)、0.2(0.2,0.3)和7.0(6.0,9.0)kPa,≥S3期分别为1.3(1.0,1.7)、0.4(0.3,0.5)、0.3(0.2,0.4)和9.0(7.4,11.0)kPa,均显著打于S0~S1期患者【分别为0.7(0.6,1.0)、0.2(0.2,0.3)、0.1(0.1,0.2)和5.0(4.1,6.1)kPa,P<0.05】;应用二元Logistics回归分析构建4种指标联合诊断≥S2和≥S3的模型分别为,Logit(≥S2)=1.303×FIB-4+9.8×GPR-0.684×APRI+0.7×LSM-7.565,其诊断≥S2肝纤维化的AUC为0.858,和Logit(≥S3)=3.307×FIB-4+5.361×GPR-4.394×APRI+0.635×LSM-9.632,其诊断≥S3肝纤维化的AUC为0.914,均显著优于各指标单独诊断(P均<0.001)。结论 在血清ALT水平正常的慢性HBV感染者中,近一半存在显著性肝纤维化。应用无创指标联合诊断肝纤维化具有一定的应用价值,值得临床开展研究。

APRI as a predictor of early viral response in chronic hepatitis C patients

AIM:To evaluate the aspartate aminotransferase(AST) to platelet ratio index(APRI) as a predictive factor of early viral response in chronic hepatitis C naive patients.METHODS:We performed an ambispective case-control study.We enrolled chronic hepatitis C naive patients who were evaluated to start therapy with PEGylated interferon α-2b(1.5 μg/kg per week) and ribavirin(>75 kg:1200mg and <75kg:1000mg).Patients were allocated into two groups,group 1:Hepatitis C patients with early viral response(EVR),group 2:Patients without EVR.Odds ratio(OR) and 95% confi dence interval(CI) were calculated to assess the relationship between each risk factor and the EVR in both groups.RESULTS:During the study,80 patients were analyzed,45 retrospectively and 35 prospectively.The mean ± SD age of our subjects was 42.9 ± 12 years;weight 70 kg(±11.19),AST 64.6 IU/mL(±48.74),alanine aminotransferase(ALT) 76.3 IU/mL(±63.08) and platelets 209000 mill/mm3(±84 429).Fifty-five(68.8%) were genotype 1 and 25(31.3%) were genotype 2 or 3;the mean hepatitis C virus RNA viral load was 2 269 061 IU/mL(±7220266).In the univariate analysis,APRI was not associated with EVR [OR 0.61(95% CI 0.229-1.655,P=0.33)],and the absence of EVR was only associated with genotype 1 [OR 0.28(95% CI 0.08-0.94,P=0.034)].After adjustment in a logistic regression model,genotype 1 remains signifi cant.CONCLUSION:APRI was not a predictor of EVR in chronic hepatitis C;Genotype 1 was the only predictive factor associated with the absence of EVR in our patients.

基于2D-SWE联合APRI建立无创模型对门静脉高压检测的评估价值研究

目的基于二维超声弹性成像技术(2D-SWE)联合APRI建立无创模型对门静脉高压检测价值进行评价,为无创检测门静脉高压提供借鉴。方法选择2019年2月至2022年1月收治的门静脉高压患者63例,依据肝静脉压力梯度(HVPG)的出血风险程度分为低危组(<12 mm Hg)20例和高危组(≥12 mm Hg)43例。测定天冬氨酸氨基转移酶(AST)、血小板(PLT)、测量肝静脉压力梯度(HVPG)。通过2D-SWE检测肝硬度,建立2D-SWE联合APRI无创模型,分析检测效能。结果2D-SWE、APRI单独对HVPG均有较好的诊断效能,其中2D-SWE曲线下面积为0.785[95%CI(0.671~0.899)],灵敏度0.558,特异度0.90,最佳截断值为18.80 kPa。APRI曲线下面积为0.786[95%CI(0.669~0.903)],灵敏度0.674,特异度0.80,最佳截断值为0.7712。2D-SWE联合APRI构建联合模型的曲线下面积为0.819[95%CI(0.711~0.927)],灵敏度0.628,特异度0.90,优于单独模型。结论2D-SWE、APRI及2D-SWE-APRI联合模型对于门静脉高压均有一定评估的价值,联合模型效能更优,可为无创检测门静脉高压提供借鉴。

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。