Department of Hepatitis Diseases, Second Xiangya Hospital, Central South University, Changsha 410011, People's Republic of China.
Eur J Gastroenterol Hepatol. 2013 Apr;25(4):428-34. doi: 10.1097/MEG.0b013e32835cb5dd.
Few studies have evaluated the validity of noninvasive models for the diagnosis of liver fibrosis in chronic hepatitis B (CHB) patients, with controversial results. In this study, we evaluated the ability of seven noninvasive models in staging liver fibrosis in a large cohort of CHB.
This is a retrospective study. A total of 1168 severe CHB patients with a clear diagnosis of liver fibrosis were included in this study. Data from routine laboratory tests were collected to establish noninvasive models. The stage of fibrosis was defined by the Metavir scoring system. Fibro-quotient, AST/ALT ratio, AST to PLT ratio index (APRI), cirrhosis discriminant score, age-PLT index (API), fibrosis index based on the four factors (FIB-4), and Lok's model were adapted as noninvasive models in this study.
FIB-4 (rs=0.542), API (rs=0.427), and Lok's model (rs=0.452) showed a higher positive correlation with liver fibrosis in CHB patients than the other models. APRI, FIB-4, and Lok's model were effective in distinguishing fibrotic stage. APRI, API, FIB-4, and Lok's model were the most effective models in distinguishing significant (S1, S2) and extensive (S3, S4) fibrosis, with area under receiver-operating characteristic values of 0.721, 0.727, 0.789, and 0.712, respectively. However, only FIB-4 and Lok's model showed higher sensitivity, specificity, positive predictive value, and negative predictive value at the cutoff value of 1.433-1.858 and 0.415-0.511, respectively.
FIB-4 and Lok's model are the most effective models for distinguishing significant and extensive fibrosis, whereas APRI, FIB-4, and Lok's model are suitable for staging fibrosis in CHB patients.
很少有研究评估非侵入性模型在慢性乙型肝炎（CHB）患者肝纤维化诊断中的有效性，结果存在争议。本研究旨在评估七种非侵入性模型在大型 CHB 患者肝纤维化分期中的能力。
这是一项回顾性研究。共纳入 1168 例明确诊断为肝纤维化的严重 CHB 患者。收集常规实验室检查数据以建立非侵入性模型。纤维化分期采用 Metavir 评分系统定义。本研究采用 Fibro-quotient、AST/ALT 比值、AST 与血小板比值指数（APRI）、肝硬化判别评分、年龄-血小板指数（API）、基于四项因素的纤维化指数（FIB-4）和 Lok 模型作为非侵入性模型。
FIB-4（rs=0.542）、API（rs=0.427）和 Lok 模型（rs=0.452）与 CHB 患者肝纤维化的正相关性高于其他模型。APRI、FIB-4 和 Lok 模型在鉴别纤维化分期方面有效。APRI、API、FIB-4 和 Lok 模型在鉴别显著（S1、S2）和广泛（S3、S4）纤维化方面最有效，其受试者工作特征曲线下面积分别为 0.721、0.727、0.789 和 0.712。然而，只有 FIB-4 和 Lok 模型在截断值为 1.433-1.858 和 0.415-0.511 时显示出更高的敏感性、特异性、阳性预测值和阴性预测值。
FIB-4 和 Lok 模型是鉴别显著和广泛纤维化的最有效模型，而 APRI、FIB-4 和 Lok 模型适用于 CHB 患者的纤维化分期。
