FIB-4和APRI评估慢性HBV感染者肝纤维化程度的效果比较

李小婷; 胡伯斌; 刘宏宇; 金超; 蔡彩莲; 王可杉; 韦艳春; 江建宁; 苏明华

doi:10.12449/JCH241212

FIB-4和APRI评估慢性HBV感染者肝纤维化程度的效果比较

DOI: 10.12449/JCH241212

广西医科大学第一附属医院感染性疾病科，南宁 530500

基金项目:

国家自然科学基金 (8216030105)

伦理学声明：本研究方案于2023年9月19日经广西医科大学第一附属医院伦理委员会批准（批号：2023-E510-01）。该项研究获得了所有患者的书面知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：李小婷、胡伯斌负责论文结构设计，数据分析，制作图表以及撰写论文，二人对本文贡献等同，为共同第一作者；刘宏宇、金超、蔡彩莲、王可杉和韦艳春负责数据收集；苏明华和江建宁负责拟定写作思路，指导撰写文章，修改文章并最后定稿。

详细信息

通信作者:
苏明华， smh9292@163.com （ORCID： 0000-0001-7831-6580）

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出版历程
- 收稿日期: 2023-11-14
- 录用日期: 2024-01-25
- 出版日期: 2024-12-25

Effectiveness of fibrosis-4 versus aspartate aminotransferase-to-platelet ratio index in evaluating liver fibrosis degree in patients with chronic HBV infection

Department of Infectious Diseases，The First Affiliated Hospital of Guangxi Medical University，Nanning 530500，China

Research funding:

National Natural Science Foundation of China (8216030105)

More Information

Corresponding author: SU Minghua， smh9292@163.com （ORCID： 0000-0001-7831-6580）

摘要

摘要: 目的比较FIB-4和APRI在慢性HBV感染者晚期肝纤维化和疾病进展中的预测效能。方法纳入2013年2月—2022年12月在广西医科大学第一附属医院感染科进行肝穿刺的慢性HBV感染者497例，其中回顾性研究404例，前瞻性研究75例。收集患者基线人口统计学特征（性别、年龄）、生化指标（ALT、AST）、血小板计数等指标，并计算FIB-4和APRI。非正态分布的计量资料两组间比较采用Mann-Whitney U检验，多组间数据比较采用Kruskal-Wallis H检验；计数资料组间比较采用χ²检验。采用ROC曲线下面积（AUC）分析评估APRI和FIB-4预测慢性HBV感染者肝纤维化程度和疾病进展的能力。结果在回顾性分析中，与FIB-4<2.67相比，FIB-4在高范围值（≥2.67）诊断为肝硬化和肝细胞癌的患者占比较高（66.19% vs 47.54%，χ²=12.75，P<0.001）。FIB-4和APRI在F0～F4期的中位值随着肝纤维化程度增加而增加，差异有统计学意义（H值分别为42.5、35.9，P值均<0.001）。在F0～F4各纤维化分期中，相同分期的FIB-4中位值均高于APRI（H=59.71，P<0.001）。FIB-4预测F3期的AUC值与APRI差异无统计学意义（0.67 vs 0.65，Z=0.71，P=0.480），预测F4期的AUC值高于APRI，差异有统计学意义（0.72 vs 0.64，Z=10.50，P<0.001）。在前瞻性研究队列中，FIB-4和APRI在出现疾病进展（慢性乙型肝炎-肝硬化）的患者中表现出随时间增加的趋势。FIB-4和APRI预测疾病进展（慢性乙型肝炎-肝硬化）的AUC分别为0.718（95%CI：0.476～0.760）和0.555（95%CI：0.408～0.703）；FIB-4预测疾病进展的准确率高于APRI（χ²=12.44，P<0.001）。结论 FIB-4和APRI均可作为评估晚期肝纤维化（F3和F4）以及预测疾病进展与否的依据，但FIB-4优于APRI。
- 乙型肝炎病毒 /
- 肝纤维化 /
- 诊断
Abstract: Objective To investigate the performance of fibrosis-4 （FIB-4） versus aspartate aminotransferase-to-platelet ratio index （APRI） in predicting advanced liver fibrosis and disease progression in patients with chronic HBV infection. Methods A total of 497 patients with chronic HBV infection who underwent liver biopsy in The First Affiliated Hospital of Guangxi Medical University from February 2013 to December 2022 were enrolled， among whom 404 were enrolled in a retrospective study and 75 were enrolled in a prospective study. Related indicators were collected， including demographic features （sex and age）， biochemical indices （alanine aminotransferase ［ALT］ and aspartate aminotransferase ［AST］）， and platelet count， and FIB-4 and APRI were calculated. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups； the chi-square test was used for comparison of categorical data between groups. The area under the ROC curve （AUC） was used to assess the ability of APRI and FIB-4 in evaluating liver fibrosis degree and disease progression in patients with chronic HBV infection. Results In the retrospective analysis， compared with the FIB-4<2.67 group， the FIB-4≥2.67 group had a significantly higher proportion of the patients who were diagnosed with liver cirrhosis or hepatocellular carcinoma （66.19% vs 47.54%， χ²=12.75， P<0.001）. The medians of FIB-4 and APRI increased significantly with liver fibrosis degree from F0 to F4 （H=42.5 and 35.9， both P<0.001）. As for the fibrosis stage of F0-F4， the median of FIB-4 was significantly higher than that of APRI in the patients with the same fibrosis stage （H=59.71， P<0.001）. FIB-4 and APRI had a similar AUC for predicting stage F3 fibrosis （0.67 vs 0.65， Z=0.71， P=0.480）， while FIB-4 had a higher AUC for predicting stage F4 fibrosis than APRI （0.72 vs 0.64， Z=10.50， P<0.001）. In the prospective study cohort， FIB-4 and APRI showed an increasing trend over time in predicting disease progression （chronic hepatitis B to liver cirrhosis）， with an AUC of 0.718 （95% confidence interval ［CI］： 0.476‍ ‍—‍ ‍0.760） and 0.555 （95%CI： 0.408‍ ‍—‍ ‍0.703）， respectively， and FIB-4 had a significantly higher accuracy than APRI in predicting disease progression （χ²=12.44， P<0.001）. Conclusion FIB-4 and APRI can be used to evaluate advanced liver fibrosis （F3 and F4） and predict disease progression， and FIB-4 is superior to APRI in certain aspects.
- Hepatitis B Virus /
- Hepatic Fibrosis /
- Diagnosis

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图 1 研究方案流程

Figure 1. Research proposal process diagram

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图 2 FIB-4和APRI在不同疾病分组中的分布

Figure 2. Distribution of FIB-4 index and APRI in patients with different diagnostic degrees

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图 3 APRI和FIB-4与肝纤维化分期的关系

Figure 3. APRI and FIB-4 in relation to histological fibrosis staging

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图 4 FIB-4和APRI诊断肝纤维化F3和F4期的ROC曲线

Figure 4. ROC curves of FIB-4 and APRI in diagnosing liver fibrosis F3 and F4

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图 5 观察期间患者病情进展与FIB-4和APRI之间的关系

Figure 5. Relationship between the progression of the patient’s condition and FIB-4 and APRI during the observation period

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表 1 基线时AST、ALT、血小板及白蛋白水平

Table 1. Levels of AST， ALT， platelets， and albumin at baseline

指标	数值
ALT（U/L）	34（22～54）
AST（U/L）	31（22～45）
血小板计数（×10⁹/L）
F0期	204.6（175.6～246.0）
F1期	203.5（173.6～241.0）
F2期	198.2（150.0～235.0）
F3期	192.9（153.5～243.0）
F4期	168.0（121.5～202.0）
白蛋白（g/L）
F0期	43.2（38.9～45.9）
F1期	42.3（38.9～45.0）
F2期	41.3（38.6～44.0）
F3期	41.5（36.9～43.4）
F4期	39.8（37.0～42.8）

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表 2 不同疾病分组的FIB-4和APRI比较

Table 2. FIB-4 and APRI indexes of different disease groups were compared

组别	FIB-4	APRI
ASC和CHB	1.0（0.7～1.6）	0.4（0.2～0.6）
LC和HCC	1.7（1.1～2.8）	1.2（0.8～1.9）
Z值	6.79	3.49
P值	<0.001	<0.001

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表 3 FIB-4和APRI诊断准确性对比

Table 3. Comparison of diagnostic accuracy between FIB-4 and APRI scores

项目	APRI		FIB-4
项目	F3	F4	F3	F4
AUC	0.65	0.64	0.67	0.72
临界值	0.249	0.264	0.329	0.357
敏感度	0.632	0.653	0.781	0.602
特异度	0.468	0.611	0.696	0.756

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表 4 前瞻性研究队列基线时AST、ALT、血小板及白蛋白水平

Table 4. Levels of AST， ALT， platelets and albumin at baseline in a prospective study cohort

指标	数值
ALT（U/L）	44（26～85）
AST（U/L）	36（26～60）
血小板计数（×10⁹/L）
F0期	204.5（161.0～254.8）
F1期	186.5（160.6～221.2）
F2期	187.0（146.3～238.3）
F3期	148.9（128.5～178.0）
白蛋白（g/L）
F0期	41.9（39.7～48.1）
F1期	42.6（39.4～45.2）
F2期	43.7（40.1～46.9）
F3期	41.3（34.3～44.8）

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