马晓辉 张 新 游 云 蒋丽丽 赵 金 阿依古力·阿不力米提 聂占国#

石河子大学医学院1(832000) 中国人民解放军新疆军区总医院消化科2

APRI、FIB-4联合对慢性乙型肝炎患者显著肝纤维化的诊断价值*

马晓辉1,2张 新2游 云2蒋丽丽2赵 金2阿依古力·阿不力米提2聂占国2#

石河子大学医学院1(832000)中国人民解放军新疆军区总医院消化科2

背景：APRI、FIB-4诊断慢性乙型肝炎患者肝纤维化程度的准确性不高，尤其是对显著肝纤维化(F≥2)。无创肝纤维化模型联合诊断已成目前研究的热点，但APRI联合FIB-4的诊断价值尚不明确。目的：探讨APRI、FIB-4联合对慢性乙型肝炎患者显著肝纤维化的诊断价值。方法：选取2011年1月—2016年10月新疆军区总医院171例慢性乙型肝炎患者，检测肝生化、血常规，行肝穿刺活检。计算APRI、FIB-4，绘制ROC曲线，确定APRI、FIB-4诊断显著肝纤维化的临界值，建立APRI和FIB-4联合诊断的模式。结果：随着肝纤维化程度的加重，APRI、FIB-4逐步升高，组间相比差异有统计学意义(P<0.05)。APRI和FIB-4的ROC曲线下面积(AUC)分别为0.812、0.770。FIB-4诊断显著肝纤维化的敏感性优于APRI。APRI联合FIB-4诊断显著肝纤维化的敏感性、特异性、阴性预测值、阳性预测值和准确性均优于两者单独使用，且模式二的诊断特异性、准确性优于模式一。结论：APRI、FIB-4联合可提高显著肝纤维化的诊断准确性。

APRI； FIB-4； 乙型肝炎, 慢性； 肝硬化； 诊断

Correspondenceto: NIE Zhanguo, Email: niezg@sina.com

Background: The diagnostic accuracy of APRI and FIB-4 for liver fibrosis in patients with chronic hepatitis B is not high, especially for significant liver fibrosis (F≥2). Noninvasive diagnosis for liver fibrosis has become a research hot spot; and the diagnostic value of APRI combined with FIB-4 is not clear.Aims: To investigate the diagnostic value of APRI combined with FIB-4 for significant liver fibrosis in patients with chronic hepatitis B.Methods: A total of 171 patients with chronic hepatitis B from January 2011 to October 2016 at General Hospital of Xinjiang Military Region were enrolled. Liver biochemical indices, routine blood test and liver biopsy pathology were performed. APRI and FIB-4 were calculated, ROC curve was drawn, and cutoff value of APRI and FIB-4 for diagnosing significant liver fibrosis was determined, and mode of APRI combined with FIB-4 for diagnosing significant liver fibrosis was established.Results: With the increase in degree of liver fibrosis, APRI and FIB-4 were gradually increased (P<0.05). Area under ROC curve (AUC) for APRI and FIB-4 were 0.812 and 0.770, respectively. The sensitivity of FIB-4 for diagnosing significant liver fibrosis was higher than that of APRI. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of APRI combined with FIB-4 for diagnosing significant liver fibrosis were superior to APRI or FIB-4 used alone; and the specificity, accuracy of mode 2 were superior to mode 1.Conclusions: APRI combined with FIB-4 can increase the accuracy for diagnosing significant liver fibrosis.

KeywordsAPRI; FIB-4; Hepatitis B, Chronic; Liver Cirrhosis; Diagnosis

目前诊断肝纤维化的“金标准”仍是肝活检，但肝活检为有创操作，存在取样误差、不同病理阅片者主观偏倚等缺点[1-3]。因此，近年肝纤维化的无创诊断已成为研究热点，其中APRI、FIB-4应用较为广泛[4]。但有报道[5]认为，APRI、FIB-4单独使用诊断肝纤维化的准确性不超过75%，误诊率和漏诊率较高。目前关于APRI、FIB-4联合应用的报道较少见，本研究探讨两者联合对慢性乙型肝炎患者显著肝纤维化(F≥2)的诊断价值，旨在提高慢性乙型肝炎患者显著肝纤维化的诊断准确性。

对象与方法

一、研究对象