APRI、FIB-4对自身免疫性肝炎肝纤维化的诊断价值  

Value of APRI and FIB-4 in diagnosis of hepatic fibrosis in autoimmune hepatitis

作　　者：王秋月 李浩[1] 刘媛媛[1] 陈迪[1] 冯璐[1] 张硕[1] 魏良洲[2] WANG Qiu-yue;LI Hao;LIU Yuan-yuan;CHEN Di;FENG Lu;ZHANG Shuo;WEI Lang-zhou(Qingdao University,266000 Qingdao,Shandong China;Department of Gastroenterology,Affiliated Hospital of Qingdao University,266000 Qingdao,Shandong China)

机构地区：[1]青岛大学,山东青岛266000 [2]青岛大学附属医院消化内科,山东青岛266000

出　　处：《临床消化病杂志》2021年第3期158-162,共5页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]研究天冬氨酸氨基转移酶/血小板比值指数(APRI)和基于4因子的肝纤维化指数(FIB-4)对判断自身免疫性肝炎(AIH)患者肝纤维化程度的意义,为AIH肝纤维化的早期诊断提供依据。[方法]选取就诊于青岛大学附属医院行肝穿刺活检并诊断为AIH的患者51例,根据肝穿刺病理结果分为F0~F4期共5组,收集研究对象的一般资料、血小板计数(PLT)、谷丙转氨酶(ALT)、谷草转氨酶(AST)等指标,计算APRI、FIB-4。绘制并分析APRI、FIB-4诊断轻度纤维化(≥F1)、显著纤维化(≥F2)、进展期纤维化(≥F3)的受试者工作特征曲线(ROC曲线)。[结果]APRI、FIB-4对≥F1缺乏敏感性和特异性;对≥F2的曲线下面积(AUC)分别为0.688、0.809,敏感性分别为58.3%、75.0%,特异性均为74.1%;对≥F3的AUC分别为0.753、0.865,敏感性分别为64.3%、78.6%,特异性分别为81.1%、89.2%。[结论]APRI、FIB-4对≥F1无明确的诊断价值,而对于≥F2及≥F3均有诊断价值,其中FIB-4的诊断效能优于APRI,且二者对于进展期纤维化的诊断效能更高。[Objective]To study the significance of aspartate aminotransferase/platelet ratio index(APRI)and fibrosis index based on the 4 factor(FIB-4)in judging the degree of hepatic fibrosis in patients with autoimmune hepatitis(AIH),and to provide basis for early diagnosis of AIH hepatic fibrosis.[Methods]Fifty-one patients with AIH diagnosed by liver biopsy in the affiliated Hospital of Qingdao University from January 2014 to December 2019 were divided into 5 groups(F0-F4)according to the pathological results of liver biopsy.The general data, platelet count(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and other indexes were collected, then the APRI and FIB-4 index were calculated.The receiver operating characteristic curve(ROC curve)of mild fibrosis(≥F1),significant fibrosis(≥F2)and advanced fibrosis(≥F3)diagnosed by APRI and FIB-4 index was drawn and analyzed.[Results]APRI and FIB-4 lack sensitivity and specificity for mild fibrosis(≥F1).Area under curve(AUC)for significant fibrosis(≥F2)was 0.688,0.809,respectively, sensitivity was 58.3% and 75.0% respectively, and specificity was 74.1%.AUC for advanced fibrosis(≥F3)was 0.753,0.865 respectively, sensitivity was 64.3% and 78.6% respectively, and specificity is 81.1% and 89.2% respectively.[Conclusion]APRI and FIB-4 index have no definite diagnostic value for mild fibrosis(≥F1),but have diagnostic value for significant hepatic fibrosis(≥F2)and advanced hepatic fibrosis(≥F3).Among them, the diagnostic efficacy of FIB-4 is better than that of APRI,and both of them are more effective in the diagnosis of advanced fibrosis.

关 键 词：自身免疫性肝炎 肝纤维化 天冬氨酸氨基转移酶/血小板比值指数 基于4因子的肝纤维化指数 

分 类 号：R575.1[医药卫生—消化系统]