APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化的早期预警价值

肝脏 ›› 2018, Vol. 23 ›› Issue (1): 22-25.

APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化的早期预警价值

俞冲, 李民, 顾玉玲, 顾尔莉

226006 南通大学附属南通第三医院、南通市第三人民医院感染科(俞冲),中西医结合肝病科(李民,顾尔莉),康复科(顾玉玲)

收稿日期:2017-09-06 发布日期:2020-04-30
通讯作者: 李民,Email:lmntsy@163.com
基金资助:
南通市社会发展项目(HS2014079、GJZ16104);南通市卫计委局青项目(WQ2014037)

Combination of APRI, FIB-4 and Fibro Touch for predicting early liver fibrosis in chronic hepatitis B patients

YU Chong, LI Min, GU Yu-ling, GU Er-li

Department of Infectious Disease, Nantong Third People's Hospital,Nantong University, Jiangsu 226006, China; Department of Science Education,Nantong Third People's Hospital,NantongUniversity,Jiangsu 226006, China; Department of Rehabilitation,Nantong Third People's Hospital,Nantong University,Jiangsu 226006, China

Received:2017-09-06 Published:2020-04-30
Contact: LI Min, Email:lmntsy@163.co

摘要/Abstract

摘要： 目的探讨APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化的早期预警价值。方法回顾性分析确诊为慢性乙型肝炎的患者402例,根据肝活组织检查结果分组:无明显肝纤维化组(S₀-S₁)146例,明显肝纤维化组(S₂-S₃)162例、早期肝硬化组(S₄)94例。每例患者进行APRI、FIB-4及Fibro Touch的评估。计算上述无创指标联合检测与肝组织病理的相关性,分析无创诊断模型对乙肝患者肝纤维化(≥S₂)的早期诊断价值,同时绘制受试者工作特征(ROC)曲线,计算最佳预测值、灵敏度及特异性。结果 APRI、FIB-4及Fibro Touch 3种无创诊断方法与肝活组织检查具有良好一致性(P<0.05),其Spearman相关系数分别为0.768、0.712、0.865。根据肝组织病理结果将入组病例分为无明显肝纤维化组(S₀-S₁)与肝纤维化组(≥S₂),对无创诊断模型行多因素二元Logistic回归分析提示APRI、FIB-4及Fibro Touch对肝纤维化均有一定的预测价值(P<0.05),其OR值分别为1.996、1.563及2.180。以APRI、FIB-4、Fibro Touch作为参数拟合Logistic二元回归方程,拟合优度高(χ²＝13.689,P＝0.126),得出上述指标联合检测对肝纤维化早期预警方程为logit(P)＝-0.556+1.119*(APRI)+1.202*(FIB-4)+1.682*(Fibro Touch)。ROC曲线分析显示3种方法联合检测对于肝纤维化(≥S₂)的早期预警价值最大,Fibro Touch检测预警效能优于APRI、FIB-4,而APRI和FIB-4在肝纤维化的早期预警价值无显著差异。采用上述指标联合对于肝纤维化(≥S₂)的早期预警曲线下面积为0.928,其最大约登指数为0.819,最佳临界值为18.14,对应的灵敏度、特异度分别为89.6%和92.3%。结论 APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化具有较高的早期预警价值,值得推广。

关键词: 肝炎,乙型,慢性, 肝纤维化, 无创诊断, 早期预警

Abstract: Objective To investigate the predictive value of aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4) and Fibro Touch for early liver fibrosis in chronic hepatitis B (CHB) patients. Methods A total of 402 CHB patients were retrospectively analyzed, including 146 cases in non-liver fibrosis (S0-S1)group, 162 cases in obvious liver fibrosis (S2-S3) group and 94 cases in early cirrhosis (S4) group according to liver pathology. The correlation between APRI, FIB-4 and Fibro Touch combined detection and liver pathology was calculated. The early diagnostic value of noninvasive diagnostic models for liver fibrosis (≥ S2)was analyzed. Meanwhile, the receiver operator characteristic (ROC) curve was performed for the best predictive value, sensitivity and specificity. Results APRI, FIB-4 and Fibro Touch were strongly correlated with liver fibrosis stages (P<0.05), with Spearman correlation coefficients of 0.768, 0.712 and 0.865, respectively. Using multivariate logistic regression analysis, APRI, FIB-4 and Fibro Touch had a certain predictive value for liver fibrosis (P<0.05), with OR values of 1.996, 1.563 and 2.180, respectively. APRI, FIB-4, Fibro Touch were fitted in binary logistic regression with high fitting degree (χ²＝13.689, P＝0.126) for early warning of liver fibrosis : logit(P)＝-0.556+1.119*(APRI)+1.202*(FIB-4)+1.682*(Fibro Touch). In predicting liver fibrosis (≥S2), the combination of APRI, FIB-4 and Fibro Touch had the best predictive value, with the area under ROC curve of 0.928 and the maximum Youden index of 0.819. Meanwhile, Fibro Touch performed better than APRI and FIB-4, which was without any significant difference between APRI and FIB-4. The cutoff value of combination of APRI, FIB-4 and Fibro Touch was 18.14, with sensitivity of 89.6% and specificity of 92.3%.Conclusion Combination of APRI, FIB-4 and Fibro Touch could help predict early liver fibrosis in CHB patients.

Key words: Chronic hepatitis B, Liver fibrosis, Noninvasive diagnosis, Early warning

俞冲, 李民, 顾玉玲, 顾尔莉. APRI、FIB-4及Fibro Touch联合检测对乙肝肝纤维化的早期预警价值[J]. 肝脏, 2018, 23(1): 22-25.

YU Chong, LI Min, GU Yu-ling, GU Er-li. Combination of APRI, FIB-4 and Fibro Touch for predicting early liver fibrosis in chronic hepatitis B patients[J]. Chinese Hepatolgy, 2018, 23(1): 22-25.

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