FIB-4指数对慢性乙型肝炎患者肝纤维化的诊断价值  

Value of FIB-4 for the diagnosis of liver fibrosis in patients with chronic hepatitis B

作　　者：张彦亮[1] 洪定玲[1] 边维良[1] 申玉英[1] 颜宁[1] 

机构地区：[1]南京医科大学附属南京第一医院肝病内科,江苏南京210006

出　　处：《胃肠病学和肝病学杂志》2009年第3期213-214,共2页Chinese Journal of Gastroenterology and Hepatology

基　　金：2005年南京市医学科技发展项目(ZKX5006)

摘　　要：目的探讨FIB-4(fibrosis index based on the 4 factor)指数对慢性乙型肝炎患者肝纤维化诊断价值。方法检测86例慢性乙肝患者血清ALT(谷丙转氨酶)、AST(谷草转氨酶)、PLT(血小板)等指标,根据病理肝纤维化分期设定两个判定点,分别为显著纤维化(≥S2级)和肝硬化(S4级),采用FIB-4指数加以评分,以肝组织病理学检查作对比,根据受试者工作特征曲线(AU-ROCs)评价FIB-4对于肝纤维化的诊断价值。结果FIB-4指数采用AUROCs加以评价,显示FIB-4≥S2级(显著纤维化)AUC曲线下面积为0.813,以1.56分值为界值,诊断显著肝纤维化敏感性、特异性、PPV和NPV分别达到86.21%、71.43%、86.2%和71.4%。S4级(肝硬化)AUC曲线下面积为0.802,以2.2分值为界值,诊断肝硬化敏感性、特异性、PPV和NPV分别达到87.5%、67.14%、37.8%和95.9%。结论FIB-4指数是一种简单易行、预测结果可靠的非侵入诊断方法,在一定程度上可替代肝活检。Objective To testify the diagnostic value of FIB-4 in patients with chronic hepatitis B （CHB） by comparing their results with histological features. Methods The serum levels of ALT, AST and PLT were evaluated. Two different endpoints were studied according to liver fibrosis stage namely significant fibrosis （ ≥ S2） and cirrhosis （ S4）, with liver biopsy as the gold standard. ROC curves were delineated for different endpoints. The area under the ROC curves reflected its diagnostic values. Results The area under curve （AUC） of FIB-4 for≥ S2 was 0. 813, when the cut-off value was set at 0. 156, the sensitivity, specificity, positive predict value （PPV） and negative predict value （NPV） for exclusion of significant fibrosis were 86.21% , 71.43% , 86.2% and 71.4% , respectively; when the cut-off value was set at 2.2, the sensitivity, specificity, positive predict value （PPV） and negative predict value （NPV） for diagnosis of cirrhosis were 87.5% , 67.14% , 37.8% and 95.9%. Conclusion The FIB-4 index is a simple, accurate, noninvasive method for assessing liver fibrosis in CHB patients and it potentially decreases the need for liver biopsy.

关 键 词：肝纤维化 FIB-4 慢性乙型肝炎 诊断 

分 类 号：R575.5[医药卫生—消化系统]