PDF下载 ( 1684 KB)
Value of fibrosis-4 index in diagnosis of liver fibrosis in autoimmune hepatitis
-
摘要: 目的通过对自身免疫性肝炎（AIH）患者临床数据进行分析,研究肝纤维化无创诊断模型FIB-4指数对AIH肝纤维化的诊断价值。方法回顾性分析2010年1月-2015年12月于首都医科大学附属北京地坛医院住院且经肝活组织检查确诊的71例AIH患者的临床资料,包括年龄、ALT、AST、PLT,计算FIB-4指数,分析FIB-4指数与肝纤维化病理分期的相关性,以及FIB-4指数诊断AIH肝纤维化的特异度和敏感度。计量资料组间比较采用Kruskal-Wallis H秩和检验。相关性分析采用Spearman秩相关分析。绘制受试者工作特征曲线,分析曲线下面积（AUC）。结果 FIB-4指数在不同肝纤维化分期间差异有统计学意义（χ2=10.134,P=0.038）,年龄、ALT、AST、PLT在不同肝纤维化分期差异均无统计学意义（P值均>0.05）。FIB-4指数与肝纤维化程度呈正相关（rs=0.338,P=0.004）,而PLT与肝纤维化程度呈负相关（rs=-0.305,P=0.010）。FIB-4指数诊断AIH肝纤维化S≥1、S≥2、S≥3的AUC分别为0.603、0.698、0.704（P值...Abstract: Objective To investigate the value of the noninvasive diagnostic model of liver fibrosis fibrosis-4 ( FIB-4) index in the diagnosis of liver fibrosis in autoimmune hepatitis ( AIH) through an analysis of the clinical data of AIH patients. Methods A retrospective analysis was performed for the clinical data of 71 AIH patients who were hospitalized in Beijing Ditan Hospital, Capital Medical University from January 2010 to December 2015 and underwent liver biopsy, including age, alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , and platelet count ( PLT) . FIB-4 index was calculated and its correlation with pathological staging of liver fibrosis was analyzed, as well as the specificity and sensitivity of FIB-4 index in the diagnosis of liver fibrosis in AIH patients. The Kruskal-Wallis H test was used for comparison of continuous data between groups. Spearman correlation analysis was also performed. The receiver operating characteristic ( ROC) curve was plotted and the area under the ROC curve ( AUC) was analyzed. Results There was a significant difference in FIB-4 index between patients with different stages of liver fibrosis ( χ2= 10. 134, P = 0. 038) , but there were no significant differences in age, ALT, AST, and PLT between these patients ( all P > 0. 05) . FIB-4 index was positively correlated with fibrosis degree and increased with the increase in fibrosis degree ( rs= 0. 338, P = 0. 004) , while PLT was negatively correlated with fibrosis degree ( rs=-0. 305, P =0. 010) . In the diagnosis of S≥1, S≥2, and S≥3 liver fibrosis in AIH, FIB-4 index had AUCs of 0. 603 ( P = 0. 408) , 0. 698 ( P =0. 004) , and 0. 704 ( P = 0. 049) , respectively. FIB-4 had relatively low sensitivity and specificity for the diagnosis of S≥1 liver cirrhosis, but had a relatively high sensitivy for the diagnosis of S≥2 liver cirrhosis ( 77. 4%) and S≥3 liver fibrosis ( 88. 9%) . Conclusion FIB-4 index does not have a significant value in evaluating liver fibrosis in patients without liver fibrosis or with mild liver fibrosis, while it has a high value in the diagnosis of marked ( S≥2) and severe ( S≥3) liver fibrosis. It has better results in the diagnosis of severe liver fibrosis than marked liver fibrosis.
-
Key words:
- FIB-4 index /
- liver cirrhosis /
- hepatitis, autoimmune /
- diagnosis
-
[1]STERLING RK, LISSEN E, CLUMECK N, et al.Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection[J].Hepatology, 2006, 43 (6) :1317-1325. [2] HENNES EM, ZENIYA M, CZAJA AJ, et al.Simplified criteria for the diagnosis of autoimmune hepatitis[J].Hepatology, 2008, 48 (1) :169-176. [3]ALVAREZ F, BERG PA, BIANCHI FB, et al.International Autoimmune Hepatitis Group Report:review of criteria for diagnosis of autoimmune hepatitis[J].J Hepatol, 1999, 31 (5) :929-938. [4]CZAJA AJ.Performance parameters of the diagnostic scoring systems for autoimmune hepatitis[J].Hepatology, 2008, 48 (5) :1540-1548. [5]Chinese Society of Infectious Diseases and Parasitology, Chinese Society of Hepatology, Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Infect Dis, 2001, 19 (1) :56-62. (in Chinese) 中华医学会传染病与寄生虫病学分会, 肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志, 2001, 19 (1) :56-62. [6]KRAWITT EL.Autoimmune hepatitis[J].N Engl J Med, 2006, 354 (1) :54-66. [7]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.Consensus on the diagnosis and management of autoimmune hepatitis (2015) [J].J Clin Hepatol, 2016, 32 (1) :9-22. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会.自身免疫性肝炎诊断和治疗共识 (2015) [J].临床肝胆病杂志, 2016, 32 (1) :9-22. [8]QIU D, WANG Q, WANG H, et al.Validation of the simplified criteria for diagnosis of autoimmune hepatitis in Chinese patients[J].J Hepatol, 2011, 54 (2) :340-347. [9]MANNS MP, CZAJA AJ, GORHAM JD, et al.Diagnosis and management of autoimmune hepatitis[J].Hepatology, 2010, 51 (6) :2193-2213. [10]PUOTI C, BELLIS L, GUARISCO R, et al.HCV carriers with normal alanine aminotransferase levels:healthy persons or severely ill patients?Dealing with an everyday clinical problem[J].Eur J Intern Med, 2010, 21 (2) :57-61. [11]FREDERIK CK, CAROLINE RD, MARTIN KI, et al.APRI:a simple bedside marker for advanced fibrosis that can avoide liver biopsy in patients with NAFLD/NASH[J].S Afr Med J, 2011, 101 (7) :477-480. [12]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for hepatitis C:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1961-1979. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.丙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1961-1979. [13]JIN WW, LIN ZH, XIN YN, et al.Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related significant fibrosis:a meta-analysis[J].J Pract Med, 2011, 27 (5) :797-799. (in Chinese) 金文文, 林中华, 辛永宁, 等.APRI指数诊断HBV相关显著肝纤维化准确性的Meta分析[J].实用医学杂志, 2011, 27 (5) :797-799. [14]MALLET V, DHALLUIN-VENIER V, ROUSSIN C, et al.The accuracy of the FIB-4 index for the diagnosis of mild fibrosis in chronic hepatitis B[J].Aliment Pharmacol Ther, 2009, 29 (4) :409-415. 期刊类型引用(5)
1. 王耀磊，王盼攀. 肝门部胆管癌患者术后并发症发生情况及其影响因素的Logistic回归分析. 医学理论与实践. 2024(11): 1822-1825 . 
百度学术2. 李明，于群，肖熙，刘影倩，黄裕存. 外科Apgar评分及POSSUM评分对老年严重胸部外伤术后预后的评估价值. 名医. 2023(09): 30-32 . 百度学术3. 朱磊，赵海淳，李珊珊，孟君. 外科Apgar评分对术前新辅助化疗进展期胃癌术后并发症的预测价值. 中国现代普通外科进展. 2022(12): 990-993 . 百度学术4. 章周海，涂从银. 肝门部胆管癌的手术疗效分析. 肝胆外科杂志. 2021(03): 223-225 . 百度学术5. 遆军锋，温陈，张小云，姜丹丹. 肝门部胆管癌术后并发症发生危险因素及术前外科改良 Apgar评分、血清总胆红素水平对并发症的预测价值. 陕西医学杂志. 2021(12): 1513-1516 . 百度学术其他类型引用(0)
-
百度学术
下载:
