RPR FIB-4 APRI及AAR对107例慢性乙型肝炎肝纤维化的诊断准确性比较  

Diagnostic accuracy of RPR, FIB-4, APRI and AAR in liver fibrosis patients with chronic hepatitis B

作　　者：吴方雄 闫蓉[1] 高保华[1] 田秋梅 徐静远 鲁晓岚 WU Fang-xiong;YAN Rong;GAO Bao-hua;TIAN Qiu-Mei;XU Jing-yuan;LU Xiao-lan(Department of gastroenterology,First Affiliated Hospital of Xian Medical University,Xi'an 710077,China)

机构地区：[1]西安医学院第一附属医院消化内科,陕西西安710077 [2]西安交通大学第二附属医院消化科,陕西西安710004 [3]复旦大学附属浦东医院消化内科,上海201399

出　　处：《中国实用内科杂志》2019年第3期249-253,共5页Chinese Journal of Practical Internal Medicine

基　　金：陕西省科技厅重点研发计划(2017SF-274);上海市浦东新区卫生系统重点学科建设资助(编号PWZx2017-27)

摘　　要：目的分析红细胞分布宽度(red cell distribution width)与血小板比率(RPR)标志物在肝纤维化诊断中的价值及准确性。并与其他已有指数如纤维化-4评分(Fibrosis-4 score,FIB-4)、天冬氨酸氨基转移酶(AST)/血小板比值指数(AST-to-platelet-ratio-index,APRI)及天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AAR)进行比较。方法2010年1月至2016年12月期间在西安医学院第一附属医院经血清学、病毒学及肝脏组织学表现诊断,且未经抗病毒治疗的慢性乙型肝炎(CHB)患者107例纳入研究,行血液学、生化学、病毒学检查及肝活检术。绘制ROC曲线并计算曲线下面积(AUROC)。结果 RPR诊断F0-1, F2-3及F4的cut-off值分别为0.079, 0.141及0.279(P<0.001);FIB-4的cut-off值分别为1.194,3.703及4.383 (P<0.001);APRI的cut-off值分别为0.384,0.660及1.441(P<0.001);AAR的cut-off值分别为0.915, 0.850及0.960 (P=0.706)。敏感度分别为RPR 76.9%,FIB-4 78.26%,AAR 97.83%及APRI 80.43%;特异度分别为RPR 81.48%,FIB-4 75.93%,AAR 14.81%及APRI 80.43%。AUROC分别为RPR 0.787,FIB-4 0.778,AAR 0.540及APRI 0.759。总cut-off值分别为RPR 0.11,FIB-4 1.94,AAR 0.60及APRI 0.59。结论 RPR, FIB-4及APRI对CHB明显纤维化及严重纤维化(硬化)具有较好的诊断准确性及预测价值,其中RPR优于FIB-4,而FIB-4又优于APRI,因此RPR是一个更好的肝纤维化评估指数。Objective We intended to evaluate the diagnostic efficiency of red cell distribution width to platelet ratio(RPR),and compare it with other three markers of fibrosis-4(FIB-4),aspartate aminotransferase-to-platelet-ratio-index(APRI)and aspartateaminotransferase-to-alanine aminotransferase ratio(AAR)for judging liver fibrosis and fibrosis severity in patients with chronic hepatitis B(CHB).Methods who had not received antiviral treatment met the requirements of this cross-sectional study.Hematology,biochemistry,virology testing and liver biopsy were performed.Receiver-operating characteristic curves were constructed and the area under the ROC curve was calculated.Results The cut-off value for distinguishing F0-1,F2-3 and F4 was 0.079,0.141 and 0.279,respectively(P<0.001)for RPR;1.194,3.703 and 4.383(P<0.001)for FIB-4;0.384,0.660 and 1.441,respectively(P<0.001)for APRI;and 0.915,0.850 and 0.960(P=0.706)for AAR.The sensitivity was 76.09% for RPR,78.26% for FIB-4,97.83% for AAR and80.43% for APRI;specificity was 81.48% for RPR,75.93% for FIB-4,14.81% for AAR and 80.43% for APRI;the AUROC was 0.787 for RPR,0.778 for FIB-4,0.540 for AAR and 0.759 for APRI.The common cut-off value was 0.11,1.94,0.60 and 0.59 for RPR,FIB-4,AAR and APRI respectively.Conclusion RPR,FIB-4 and APRI have good efficiency in appraising significant and severe fibrosis in patients with CHB,however RPR is superior to FIB-4 and FIB-4 is superior to APRI,therefore,RPR is a better index in evaluating liver cirrhosis.

关 键 词：RPR FIB-4 APRI AAR 纤维化 

分 类 号：R512.6[医药卫生—内科学]