白球比联合FIB-4对慢性HBV感染者肝纤维化程度的预测价值

摘要/Abstract

摘要： 目的探讨白球比联合FIB-4对慢性HBV感染患者肝纤维化程度的预测价值。方法纳入2004年2月至2024年12月广西医科大学第一附属医院收治的慢性HBV感染者297例。收集患者基线人口学特征、病理学检查结果、生化指标(TBil、Alb、Glo、ALT、AST、PLT),并计算白球比、FIB-4和APRI,将白球比与FIB-4联合,构成联合模型。依据METAVIR评分,将患者分为非显著性肝纤维化组(S0~2期)和显著性肝纤维化组(S ≥3期)。采用单因素、多因素logistic回归分析筛选出与HBV感染者肝纤维化显著相关的独立预测因子,用受试者工作特征(ROC)曲线判断这些指标对肝纤维化程度的预测价值,计算曲线下面积(AUC)、最佳阈值、灵敏度及特异度。结果 297例慢性HBV感染者患者中,显著性肝纤维化患者(S3~S4)79例,非显著性肝纤维化患者(S0~S2)218例。显著肝纤维化患者的Glo、ALT、AST水平及FIB-4、APRI显著高于非显著肝纤维化组,分别为32.2(27.7,35.1)g/L比27.5(25.4,30.7)g/L、49(27,85.5)U/L比32(22,49)U/L、44(30,79)U/L比27(21,37)U/L、1.546(1.0205,2.5972)比0.9492(0.6998,1.4103)、0.6439(0.4206,1.2075)比0.3555(0.2451,0.5708),(Z=-5.418、-3.658、-5.332、-5.369、-5.696,P<0.05);Alb、白球比、PLT显著低于非显著纤维化组,分别为41.5(36.9,43.8)g/L比42.6(39.8,45.5)g/L、1.2707(1.1138,1.4765)比1.5295(1.3742,1.6873)、172(138,231)×10⁹/L比199(165,239)×10⁹/L,(Z=-2.758、-6.349、-2.645,P<0.05)。多因素logistic回归分析提示白球比是慢性HBV感染患者显著肝纤维化的独立预测因子(OR=0.091,P<0.05)。ROC曲线评估白球比预测慢性HBV感染者患者肝纤维化程度临床价值,最佳截断值、AUC、灵敏度、特异度及准确率分别为1.3601、0.741、64.6%、76.6%、73.4%;APRI的最佳截断值、AUC、灵敏度、特异度及准确率分别为0.4744、0.716、70.9%、67.4%、68.35%; FIB-4的最佳截断值、AUC、灵敏度、特异度及准确率分别为1.5911、0.704、49.4%、83.9%、74.75%;联合模型的最佳截断值、AUC、灵敏度、特异度及准确率分别为0.2424、0.767、74.7%、72.9%、73.4%。4个诊断模型的AUC两两比较,差异无统计学意义。4个诊断方法的灵敏度差异有统计学意义(χ²=21.321,P<0.001),其中,联合模型、APRI诊断方法的灵敏度均显著高于FIB-4(P<0.0083),而联合模型、APRI和白球比的灵敏度两两间差异无统计学意义。4种诊断方法的特异度比较,差异有统计学意义(χ²=29.739,P<0.001),其中,FIB-4的特异度显著高于其他3种方法(P<0.0083),白球比的特异度显著高于APRI(P<0.0083),而联合诊断和白球比的特异度差异无统计学意义。结论白球比可作为预测HBV感染患者肝纤维化程度的指标,白球比联合FIB-4构成的联合模型诊断显著纤维化患者性能最好。

关键词: 乙型肝炎病毒, 肝纤维化, 白球比

Abstract: Objective To explore the predictive value of albumin-to-globulin ratio for assessing liver fibrosis in patients with chronic HBV infection and to determine clinical diagnostic thresholds. Methods A total of 297 patients with chronic HBV infection who underwent liver puncture at the First Affiliated Hospital of Guangxi Medical University from February 2004 to December 2024 were included. Baseline demographic characteristics (gender, age), pathological examination results, and biochemical indicators [total bilirubin(TBil), albumin(Alb), globulin(Glo), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and platelet count (PLT)] were collected, and the albumin-to-globulin ratio, fibrosis 4 index (FIB-4), and aspartate aminotransferase-to-platelet ratio index (APRI) were calculated. A combined model of albumin-to-globulin ratio with FIB-4 was constructed. Based on the METAVIR score, patients were divided into a non-significant liver fibrosis group (stages S0~2) and a significant liver fibrosis group (stage S≥3). Univariate and multivariate logistic regression was used to identify the independent predictive factors that significantly associated with liver fibrosis in HBV-infected patients. The predictive value of these indicators for liver fibrosis was assessed using receiver operating characteristic (ROC) curves, and the area under the curve (AUC), optimal thresholds, sensitivity, and specificity were calculated. Mann-Whitney U tests were used to compare non-normally distributed quantitative data between the two groups, while the χ² test was used for comparisons of categorical data between groups. Results In the 297 chronic HBV infection patients, there were 79 patients with significant liver fibrosis (S3~S4) and 218 patients with non-significant liver fibrosis (S0~S2). The levels of Glo, ALT, and AST, as well as FIB-4 and APRI in patients with significant liver fibrosis were higher than those in the non-significant fibrosis group [32.2 (27.7, 35.1) g/L vs. 27.5 (25.4, 30.7) g/L, 49 (27, 85.5) U/L vs. 32 (22, 49) U/L, 44 (30, 79) U/L vs. 27 (21, 37) U/L, 1.546 (1.0205, 2.5972) vs. 0.9492 (0.6998, 1.4103), 0.6439 (0.4206, 1.2075) vs. 0.3555 (0.2451, 0.5708), Z=-5.418, -3.658, -5.332, -5.369, -5.696, respectively, P<0.05], while Alb, albumin/globulin ratio, and PLT were significantly lower in the non-significant fibrosis group [41.5 (36.9-43.8) g/L vs. 42.6 (39.8, 45.5) g/L, 1.2707 (1.1138, 1.4765) vs. 1.5295 (1.3742, 1.6873), 172 (138, 231)×10⁹/L vs. 199 (165, 239)×10⁹/L, Z=-2.758, -6.349, -2.645, P<0.05]. Multivariate logistic regression analysis indicated that the albumin-to-globulin ratio is an independent predictor of significant liver fibrosis in chronic HBV infection patients (OR=0.091, P<0.05). The optimal cutoff values, AUC, sensitivity, specificity, and accuracy of albumin-to-globulin ratio in predicting the degree of liver fibrosis in patients with chronic HBV infection are 1.3601, 0.741, 64.6%, 76.6%, and 73.4%, respectively; for APRI, they were 0.4744, 0.716, 70.9%, 67.4%, and 68.35%; for FIB-4, they were 1.5911, 0.704, 49.4%, 83.9%, and 74.75%; for the combined model, they were 0.2424, 0.767, 74.7%, 72.9%, and 73.4%. Pairwise comparisons of the AUCs of the four diagnostic models showed no statistically significant differences. The differences in sensitivities among the four diagnostic methods were statistically significant (χ²=21.321, P<0.001), with the sensitivities of the combined model and the APRI method being significantly higher than that of FIB-4 (P<0.0083), while there were no statistically significant differences in pairwise comparisons among the combined model, APRI, and the albumin-to-globulin ratio. The comparison of the specificities of the four diagnostic methods revealed statistically significant differences (χ²=29.739, P<0.001), with the specificity of FIB-4 being significantly higher than that of the other three methods (P<0.0083), and the specificity of the albumin-to-globulin ratio being significantly higher than that of APRI (P<0.0083), whereas the difference in specificity between the combined diagnosis and the albumin-to-globulin ratio was not statistically significant. Conclusion The albumin-to-globulin ratio can serve as an indicator for predicting the degree of liver fibrosis in patients with HBV infection, and the combined diagnostic model of the albumin-to-globulin ratio and FIB-4 performs best in diagnosing patients with significant fibrosis.

Key words: Hepatitis B virus, Liver fibrosis, Albumin to globulin ratio

零芳蓬, 陈雪梅, 范冰凌, 蓝诗雨, 李小婷, 韦美料, 韦来安, 江建宁, 苏明华. 白球比联合FIB-4对慢性HBV感染者肝纤维化程度的预测价值[J]. 肝脏, 2026, 31(4): 503-507.

LING Fang-peng, CHEN Xue-mei, FAN Bing-ling, LAN Shi-yu, LI Xiao-ting, WEI Mei-liao, WEI Lai-an, JIANG Jian-ning, SU Ming-hua. The predictive value of albumin-to-globulin ratio combined with FIB-4 for assessing the degree of liver fibrosis in patients with chronic HBV infection[J]. Chinese Hepatolgy, 2026, 31(4): 503-507.

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