徐旭,赵雪珂,陈有望
XU Xu,ZHAO Xueke,CHEN Youwang

• 1:贵州医科大学附属医院肝病实验室
• 2:贵州医科大学附属医院感染科
• 3:贵州医科大学附属医院小儿外科

摘要(Abstract)：

目的 探究无创模型评估慢乙肝肝纤维化程度的临床使用价值。方法 收集经肝穿诊断为肝纤维化的92例慢乙肝患者资料，根据肝纤维化程度将患者分为轻度肝纤维化组和显著肝纤维化组，采用全自动生化分析仪检测2组患者静脉血天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT),血细胞分析仪检测2组患者静脉血血小板计数(PLT)及红细胞分布宽度(RDW),计算AST与ALT比值(AAR)、AST与PLT比值(APRI)、RDW与PLT比值(RPR)及4因子肝纤维化指数(FIB-4);应用受试者工作特征曲线(ROC)曲线下面积(AUC)评价上述无创模型对肝纤维化的诊断价值。结果 轻度纤维化组血清ALT与AST、APRI、RPR以及FIB-4均低于显著纤维化组(P<0.05),PLT和AAR则高于显著纤维化组(P<0.05);应用AAR、APRI、RPR和FIB-4评估慢性乙型肝炎肝纤维化程度的AUC分别为0.406、0.711、0.729和0.692;4项指标联合诊断的AUC为0.741,显著高于4项中的任何1项单独指标(P<0.05)。结论 APRI、RPR和FIB-4是诊断慢乙肝患者肝纤维化程度的有效指标，4种模型联合应用可提高乙肝肝纤维化程度诊断和预测的准确性。
Objective To explore the clinical value of non-invasive model in evaluating the degree of hepatic fibrosis in chronic hepatitis B. Methods The data of 92 patients with chronic hepatitis B diagnosed as hepatic fibrosis by liver puncture biopsy were collected. According to the degree of hepatic fibrosis, the patients were divided into mild hepatic fibrosis and significant hepatic fibrosis groups. Automatic biochemical analyzer was used to detect aspartate aminotransferase(AST) and alanine aminotransferase(ALT) in venous blood of the patients. Blood cell analyzer was used to measure platelet(PLT) count and red blood cell distribution width(RDW) in venous blood of the patients. AST/ALT ratio(AAR), AST/PLT ratio(APRI), RDW/PLT ratio(RPR) and fibrosis index based on the 4 factors(FIB-4) were calculated. Area under receiver operating characteristic(ROC) curve(AUC) was used to evaluate the diagnostic value of the above non-invasive model for hepatic fibrosis. Results Serum ALT, AST, APRI, RPR, and FIB-4 were lower in mild hepatic fibrosis group than those in significant hepatic fibrosis group(P<0.05), while PLT and AAR were higher than those in significant hepatic fibrosis group(P<0.05). The AUCs of AAR, APRI, PPR, and FIB-4 for evaluating the degree of hepatic fibrosis in chronic hepatitis B were 0.406, 0.711, 0.729, and 0.692, respectively. The AUC for the combined four indicators was 0.741, which was significantly higher than any individual indicator alone(P<0.05). Conclusion APRI, RPR, and FIB-4 are effective indicators for diagnosing the degree of hepatic fibrosis in patients with chronic hepatitis B. Combined application of the four models can improve the accuracy of diagnosis and prediction of the fibrosis in hepatitis B.

关键词(KeyWords)： 慢性乙型肝炎;肝纤维化;无创诊断模型;天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值;天门冬氨酸氨基转移酶/血小板比值;红细胞分布宽度/血小板比值;FIB-4指数
chronic hepatitis B;hepatic fibrosis;noninvasive diagnostic model;aspartate aminotransferase-to-alanine aminotransferase ratio;aspartate aminotransferase-to-platelet ratio index;red blood cell distribution width-to-platelet ratio;FIB-4 index

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技计划项目(黔科合支撑[2021]一般094);贵州省科技计划项目(黔科合成果-LC[2023]006);; 贵州省卫生健康委科学技术基金项目(gzwkj2023-448)

作者(Author): 徐旭,赵雪珂,陈有望
XU Xu,ZHAO Xueke,CHEN Youwang

DOI: 10.19367/j.cnki.2096-8388.2024.04.021

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