FibroScan、AAR、APRI、FIB-4及其联合应用对乙型肝炎患者肝纤维化程度诊断效价的意义  

The significance of FibroScan,AAR,APRI,FIB-4 and their combinations in the assessment of liver fibrosis in patients with hepatitis B

作　　者：丁德平[1] 刘平[1] 陈琳莉[1] 康健[1] 张银华[1] 马德强[1] 陈悦[1] 孟忠吉[1] 

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)感染科,湖北十堰442000

出　　处：《中西医结合肝病杂志》2016年第5期267-269,286,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：湖北省自然科学基金面上项目(No.2014CFB645);国家自然科学基金(No.81541140)

摘　　要：目的:评估FibroScan、AST/ALT(AAR)、AST/PLT(APRI)、FIB-4及其联合应用对乙型肝炎患者肝纤维化程度的诊断效价。方法:回顾性分析406例慢性乙型肝炎及乙肝肝硬化住院患者,收集所有患者的肝脏硬度(LS)、AAR、APRI及FIB-4指数,比较慢性乙型肝炎和乙肝肝硬化两组患者LS、AAR、APRI及FIB-4指数的差异性,采用ROC曲线评价4项肝纤维化诊断指标鉴别慢性乙型肝炎及乙肝肝硬化不同疾病阶段的能力,并分析LS、AAR、APRI、FIB-4对于肝纤维化程度的评价相关性。结果:LS、AAR、FIB-4指数对肝纤维化的诊断效价在慢性乙型肝炎组与乙肝肝硬化组间比较差异具有显著性意义(P<0.001);ROC曲线分析显示,鉴别诊断慢性乙型肝炎及乙肝肝硬化的LS、AAR、APRI及FIB-4指数ROC曲线下面积分别为0.866,0.772、0.632、0.885;鉴别诊断代偿期与失代偿乙肝肝硬化的LS、AAR、APRI及FIB-4指数ROC曲线下面积分别为0.627、0.666、0.795、0.820;LS分别与AAR、APRI、FIB-4指数间的Pearson相关系数分别为0.313、0.265、0.156,具有显著性意义(P<0.05)。结论:LS、AAR、APRI及FIB-4指数可作为临床诊断及鉴别诊断乙型肝炎相关肝硬化的艮好指标。Objective： To assess the effects of FibroScan, aspartate aminotransferase to alanine aminotransferase ratio index （AAR） , aspar- tate aminotransferase to platelet ratio index （APRI）, fibrosis index based on the 4 factor （FIB-4） and their combinations on liver fibrosis in pa- tients with hepatitis B. Methods： Four hundred and six hospitalized patients with chronic hepatitis B （CHB） and cirrhosis in our hospital were analyzed retrospectively and collected patients clinical indicators, including liver stiffness （LS）, AAR, APRI and FIB-4, and then compared the differences of these indicators between CHB group and hepatitis B with cirrhosis group. Receiver operating curve （ROC） was used to evalu- ate the differentiating capacity of these indicators on CHB and liver cirrhosis. Results： Four indicators related to liver cirrhosis had a significance difference between two groups （P 〈0.001 ） ; the under ROC curve areas of LS, AAR, APRI and FIB-4 for differential diagnosis of CHB and liver cirrhosis were 0.866, 0. 772, 0. 632 and 0. 885, respectively. The under ROC curve areas of LS, AAR, APRI and FIB-4 for differential diagnosis of liver cirrhosis at compensatory stage and decompensatory stage were 0.627, 0.666, O. 795 and O. 820, respectively. Conclusion： LS, AAR, APRI and FIB-4 were good indicators as clinical diagnosis and differential diagnosis on hepatitis B related cirrhosis.

关 键 词：慢性乙型肝炎 肝纤维化程度 肝硬化 瞬时弹性成像技术 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]