HA、Ⅳ-C、APRI及Fib-4对乙型肝炎后肝纤维化的诊断效果

doi:10.3969/j.issn.1673-8640.2019.06.013

摘要/Abstract

摘要：

目的分析乙型肝炎后肝纤维化患者的透明质酸（HA）、Ⅳ型胶原（Ⅳ-C）、天门冬氨酸氨基转移酶（AST）/血小板（PLT）比值（APRI）以及纤维蛋白原（Fib）-4对乙型肝炎后肝纤维化的诊断效果。方法选取乙型肝炎患者320例,记录患者年龄、性别等信息。根据Metavir评分系统分级。采用化学发光法检测患者血清样本的HA、Ⅳ-C,计算APRI及Fib-4,采用受试者工作特征（ROC）曲线对4个指标的诊断效果进行评估。结果 HA、Ⅳ-C、APRI及Fib-4与肝纤维化分期呈正相关,差异有统计学意义（P<0.05）,HA、Ⅳ-C、APRI以及Fib-4的曲线下面积（AUC）分别为0.646、0.695、0.743、0.701。结论 4个血清学指标和乙型肝炎后纤维化具有很好的相关性,对临床进行无创肝纤维化诊断具有一定的价值。

关键词: 透明质酸, Ⅳ型胶原, 天门冬氨酸氨基转移酶/血小板比值, 纤维蛋白原, 慢性乙型肝炎, 肝纤维化

Abstract:

Objective To evaluate the diagnosis efficiency of hyaluronic acid（HA） and Ⅳ-collagen（Ⅳ-C）in patients with liver fibrosis after hepatitis B. Aspartate aminotransferase（AST）/platelet（PLT） ratio（APRI） and fibrosis 4 score（Fib-4）for liver fibrosis after hepatitis B. Methods A total of 320 patients with hepatitis B were enrolled. Their general data,like age and sex,were recorded. The patients were classified according to the Metavir scoring system. The HA and Ⅳ-C levels were detected by chemiluminescence,and APRI and Fib-4 were calculated. Their roles have been evaluated according to receiver operating characteristic（ROC）curve analysis. Results HA,Ⅳ-C,APRI and Fib-4 were positively correlated with the stage of liver fibrosis with statistical significance（P<0.05）,and the areas under curves（AUC） of HA,Ⅳ-C,APRI and Fib-4 were 0.646,0.695,0.743 and 0.701,respectively. Conclusions HA,Ⅳ-C,APRI and Fib-4 have correlations with hepatitis B-related liver fibrosis. They are potential in the non-invasive diagnosis of hepatitis B-related liver fibrosis.

Key words: Hyaluronic acid, Ⅳ-collagen, Aspartate aminotransferase/platelet ratio, Fibrosis 4 score, Chronic hepatitis B, Liver fibrosis

中图分类号:

R446.1

俞晓春, 胡旭姣, 章家青, 国蕾蕾. HA、Ⅳ-C、APRI及Fib-4对乙型肝炎后肝纤维化的诊断效果[J]. 检验医学, 2019, 34(6): 539-542.

YU Xiaochun, HU Xujiao, ZHANG Jiaqing, GUO Leilei. Roles of HA,Ⅳ-C,APRI and Fib-4 in the diagnosis of hepatitis B-related liver fibrosis[J]. Laboratory Medicine, 2019, 34(6): 539-542.

图/表 3

参考文献 13

[1]	CRISAN D,RADU C,LUPSOR M,et al.Two or more synchronous combination of noninvasive tests to increase accuracy of liver fibrosis assessement in chronic hepatitis C;results from a cohort of 446 patients[J]. Hepat Mon,2012,12(3):177-184.
[2]	MÁTRAI J,CANTORE A,BARTHOLOMAE C C,et al. Hepatocyte-targeted expression by integrase-defective lentiviral vectors induces antigen-specific tolerance in mice with low genotoxic risk[J]. Hepatology,2011,53(5):1696-1707.
[3]	Lichtinghagen R,Bahr M J.Noninvasive diagnosis of fibrosis in chronic liver disease[J]. Expert Rev Mol Diagn,2004,4(5):715-726.
[4]	Friedrich-Rust M,Rosenberg W,Parkes J,et al.Comparison of ELF,FibroTest and FibroScan for the non-invasive assessment of liver fibrosis[J]. BMC Gastroenterol,2010,10:103.
[5]	中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎诊断标准(2015年版)[J]. 中西医结合肝病杂志,2015,25(6):384.
[6]	张敏. 血清HA检测在诊断肝纤维化中的临床应用[J]. 中国疗养医学,2015,24(12):1326-1327.
[7]	焦运,杨安宁,孙岳,等. 乙肝肝硬化患者血清MMP-2、HA、LN和IV-C的水平及意义[J]. 宁夏医科大学学报,2015,37(11):1286-1288.
[8]	Kitajima T,Kaido T,Hamaguchi Y,et al.Validation of the FIB-4 index for evaluation of fibrosis in patients with recurrent hepatitis C after living donor liver transplantation:a single center experience[J]. Hepatol Res,2016,46(8):752-757.
[9]	BOTA S,HERKNER H,SPOREA I,et al.Meta-analysis:ARFI elastography versus transient elastography for the evaluation of liver fibrosis[J]. Liver Int,2013,33(8):1138-1147.
[10]	Castera L.Invasive and non-invasive methods for the assessment of fibrosis and disease progression in chronic liver disease[J]. Best Pract Res Clin Gastroenterol,2011,25(2):291-303.
[11]	刘健,张蓓蓓,李春娜. 慢性乙型肝炎患者血清肝纤四项与肝组织病理相关性分析[J]. 临床合理用药杂志,2014,7(32):9-10.
[12]	GÜzelbulut F,Cetinkaya Z A,Sezikli M,et al.AST-platelet ratio index,Forns index and FIB-4 in the prediction of significant fibrosis and cirrhosis in patients with chronic hepatitis C[J]. Turk J Gastroenterol,2011,22(3):279-285.
[13]	CastÉra L,Sebastiani G,Le Bail B,et al.Prospective comparison of two algorithms combining non-invasive methods for staging liver fibrosis in chronic hepatitis C[J]. J Hepatol,2010,52(2):191-198.

肝纤维化分期	性别		年龄（岁）	HA （ng/mL）	Ⅳ-C （ng/mL）	APRI（ng/mL）	Fib-4（ng/mL）
肝纤维化分期	男（例）	女（例）	年龄（岁）	HA （ng/mL）	Ⅳ-C （ng/mL）	APRI（ng/mL）	Fib-4（ng/mL）
F0	21	10	45.10±11.60	71.77±38.41	68.41±31.58	0.25（0.16~0.34）	0.96（0.54~1.38）
F1	59	20	42.50±14.10	83.71±35.26	79.56±40.15	0.44（0.33~0.55）	1.14（0.85~1.41）
F2	65	12	41.60±9.80	91.44±40.51	90.46±50.47	1.05（0.41~1.63）	1.87（1.13~2.61）
F3	26	19	46.70±10.40	98.47±43.16	105.47±52.55	1.41（0.58~2.24）	2.00（1.41~2.69）
F4	9	4	40.30±7.40	118.74±49.24	119.89±42.62	1.68（0.76~2.60）	3.18（2.12~4.70）
P值	0.945		0.64	<0.05	<0.05	<0.05	<0.05

肝纤维化分期	性别		年龄（岁）	HA （ng/mL）	Ⅳ-C （ng/mL）	APRI（ng/mL）	Fib-4（ng/mL）
肝纤维化分期	男（例）	女（例）	年龄（岁）	HA （ng/mL）	Ⅳ-C （ng/mL）	APRI（ng/mL）	Fib-4（ng/mL）
F0	21	10	45.10±11.60	71.77±38.41	68.41±31.58	0.25（0.16~0.34）	0.96（0.54~1.38）
F1	59	20	42.50±14.10	83.71±35.26	79.56±40.15	0.44（0.33~0.55）	1.14（0.85~1.41）
F2	65	12	41.60±9.80	91.44±40.51	90.46±50.47	1.05（0.41~1.63）	1.87（1.13~2.61）
F3	26	19	46.70±10.40	98.47±43.16	105.47±52.55	1.41（0.58~2.24）	2.00（1.41~2.69）
F4	9	4	40.30±7.40	118.74±49.24	119.89±42.62	1.68（0.76~2.60）	3.18（2.12~4.70）
P值	0.945		0.64	<0.05	<0.05	<0.05	<0.05

血清学指标	r值	P值
HA	0.33	<0.01
Ⅳ-C	0.48	<0.01
APRI	0.51	<0.01
Fib-4	0.65	<0.01

血清学指标	r值	P值
HA	0.33	<0.01
Ⅳ-C	0.48	<0.01
APRI	0.51	<0.01
Fib-4	0.65	<0.01

血清学指标	临界值	敏感性（%）	特异性（%）
HA	89.2	60.0	71.0
Ⅳ-C	80.7	70.0	85.0
APRI	1.3	75.0	90.0
Fib-4	1.4	71.7	85.0
4项联合	94.1	95.8	91.6