Qingdao Municipal Hospital, Qingdao 266021, Shandong Province, China.
BMC Gastroenterol. 2012 Feb 14;12:14. doi: 10.1186/1471-230X-12-14.
The aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to systematically review the performance of the APRI in predicting significant fibrosis and cirrhosis in hepatitis B-related fibrosis.
Areas under summary receiver operating characteristic curves (AUROC), sensitivity and specificity were used to examine the accuracy of the APRI for the diagnosis of hepatitis B-related significant fibrosis and cirrhosis. Heterogeneity was explored using meta-regression.
Nine studies were included in this meta-analysis (n = 1,798). Prevalence of significant fibrosis and cirrhosis were 53.1% and 13.5%, respectively. The summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.79 and 0.75, respectively. For significant fibrosis, an APRI threshold of 0.5 was 84% sensitive and 41% specific. At the cutoff of 1.5, the summary sensitivity and specificity were 49% and 84%, respectively. For cirrhosis, an APRI threshold of 1.0-1.5 was 54% sensitive and 78% specific. At the cutoff of 2.0, the summary sensitivity and specificity were 28% and 87%, respectively. Meta-regression analysis indicated that the APRI accuracy for both significant fibrosis and cirrhosis was affected by histological classification systems, but not influenced by the interval between Biopsy & APRI or blind biopsy.
Our meta-analysis suggests that APRI show limited value in identifying hepatitis B-related significant fibrosis and cirrhosis.
天冬氨酸氨基转移酶-血小板比值指数（APRI）是一种具有有限费用和广泛可用性的工具，是一种有前途的替代肝活检的非侵入性方法，用于检测肝纤维化。本研究的目的是系统地回顾 APRI 在预测乙型肝炎相关纤维化中的显著纤维化和肝硬化的表现。
使用汇总受试者工作特征曲线下面积（AUROC）、敏感性和特异性来检查 APRI 对乙型肝炎相关显著纤维化和肝硬化的诊断准确性。使用荟萃回归探索异质性。
本荟萃分析纳入了 9 项研究（n=1798）。显著纤维化和肝硬化的患病率分别为 53.1%和 13.5%。APRI 对显著纤维化和肝硬化的汇总 AUC 分别为 0.79 和 0.75。对于显著纤维化，APRI 阈值为 0.5 的敏感性为 84%，特异性为 41%。在截断值为 1.5 时，汇总敏感性和特异性分别为 49%和 84%。对于肝硬化，APRI 阈值为 1.0-1.5 的敏感性为 54%，特异性为 78%。在截断值为 2.0 时，汇总敏感性和特异性分别为 28%和 87%。荟萃回归分析表明，APRI 对显著纤维化和肝硬化的准确性受组织学分类系统的影响，但不受活检与 APRI 之间的间隔或盲法活检的影响。
我们的荟萃分析表明，APRI 在识别乙型肝炎相关显著纤维化和肝硬化方面的价值有限。
