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背景:APRI、FIB-4诊断慢性乙型肝炎患者肝纤维化程度的准确性不高,尤其是对显著肝纤维化(F≥2)。无创肝纤维化模型联合诊断已成目前研究的热点,但APRI联合FIB-4的诊断价值尚不明确。目的:探讨APRI、FIB-4联合对慢性乙型肝炎患者显著肝纤维化的诊断价值。方法:选取2011年1月—2016年10月新疆军区总医院171例慢性乙型肝炎患者,检测肝生化、血常规,行肝穿刺活检。计算APRI、FIB-4,绘制ROC曲线,确定APRI、FIB-4诊断显著肝纤维化的临界值,建立APRI和FIB-4联合诊断的模式。结果:随着肝纤维化程度的加重,APRI、FIB-4逐步升高,组间相比差异有统计学意义(P<0.05)。APRI和FIB-4的ROC曲线下面积(AUC)分别为0.812、0.770。FIB-4诊断显著肝纤维化的敏感性优于APRI。APRI联合FIB-4诊断显著肝纤维化的敏感性、特异性、阴性预测值、阳性预测值和准确性均优于两者单独使用,且模式二的诊断特异性、准确性优于模式一。结论:APRI、FIB-4联合可提高显著肝纤维化的诊断准确性。
BACKGROUND: The accuracy of APRI and FIB-4 in diagnosing chronic hepatitis B patients is not high enough, especially for significant liver fibrosis (F≥2). Noninvasive liver fibrosis model joint diagnosis has become a hot spot, but the diagnostic value of APRI combined with FIB-4 is not yet clear. Objective: To investigate the diagnostic value of APRI and FIB-4 combined for the detection of significant hepatic fibrosis in patients with chronic hepatitis B. Methods: From January 2011 to October 2016, 171 patients with chronic hepatitis B from the Xinjiang General Hospital of Xinjiang Military Command were enrolled in the study. Biochemical tests and blood tests were performed on liver biopsies. The APRI and FIB-4 were calculated and ROC curves were plotted to determine the critical value of APRI and FIB-4 for diagnosis of significant liver fibrosis, and to establish a combined diagnosis mode of APRI and FIB-4. Results: With the aggravation of hepatic fibrosis, APRI and FIB-4 gradually increased, the difference between groups was statistically significant (P <0.05). The area under the ROC curve (AUC) of APRI and FIB-4 were 0.812 and 0.770, respectively. FIB-4 is superior to APRI in diagnosing significant liver fibrosis. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of APRI combined with FIB-4 in diagnosing significant hepatic fibrosis were better than those of the two alone, and the diagnostic specificity and accuracy of mode II were better than that of model one. Conclusion: The combination of APRI and FIB-4 can improve the diagnostic accuracy of significant hepatic fibrosis.