AST/ALT 比值、APRI 和 FIB-4 与 FibroScan 用于评估伊朗霍尔木兹甘省班达尔阿巴斯市慢性乙型肝炎患者的肝纤维化。
AST/ALT ratio, APRI, and FIB-4 compared to FibroScan for the assessment of liver fibrosis in patients with chronic hepatitis B in Bandar Abbas, Hormozgan, Iran.
机构信息
Department of Internal Medicine, Infectious and Tropical Disease Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran.
Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran.
出版信息
BMC Gastroenterol. 2023 May 11;23(1):145. doi: 10.1186/s12876-023-02780-w.
BACKGROUND
Chronic hepatitis B (CHB) is a significant risk factor for liver-related disorders. Hepatic fibrosis staging by liver biopsy in these patients can lead to complications. This study aimed to compare aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, AST to platelet ratio index (APRI), and fibrosis-4 (FIB-4) with FibroScan results for the evaluation of hepatic fibrosis in CHB patients.
METHODS
This cross-sectional study included patients with CHB referred to the outpatient clinics of Bandar Abbas, Hormozgan, Iran, in 2021. The age and sex of the participants were noted. FibroScan evaluation was done for all subjects. Moreover, AST, ALT, and platelet counts were measured in their blood samples within one month of the FibroScan evaluation.
RESULTS
Of the 267 CHB patients evaluated in the present study (mean age: 45.45 ± 18.16 years), 173 (64.8%) were male. According to FibroScan results, 65 CHB patients (24.3%) had F1, 53 (19.9%) F2, 38 (14.2%) F3, and 20 (7.5%) F4 liver fibrosis. There was a significant correlation between FibroScan results and the three indices of AST/ALT ratio, APRI, and FIB-4 (P < 0.001), with the strongest correlation between FibroScan results and APRI (r = 0.682). With an area under the receiver operating characteristic (AUROC) curve of 0.852 (95% confidence interval [CI] 0.807; 0.897, P < 0.001), APRI ≥ 0.527 had the best diagnostic accuracy (77.15%) for the detection of any grade of liver fibrosis. Although the AUROC curve of APRI and FIB-4 was similar (0.864) for distinguishing between F3/F4 and F0-F2 of liver fibrosis, FIB-4 had the best diagnostic accuracy (82.02%).
CONCLUSIONS
APRI can rule out 95.4% of F3/F4 of liver fibrosis and rule in any grade of liver fibrosis in CHB patients by 90.78%. Therefore, APRI appears to be the best substitute for FibroScan in the assessment of liver fibrosis in patients with CHB.
背景
慢性乙型肝炎（CHB）是肝脏相关疾病的重要危险因素。对这些患者进行肝活检进行肝纤维化分期可能会导致并发症。本研究旨在比较天门冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）比值、天冬氨酸氨基转移酶与血小板比值指数（APRI）和纤维化-4（FIB-4）与 FibroScan 结果在 CHB 患者肝纤维化评估中的应用。
方法
这是一项横断面研究，纳入了 2021 年在伊朗霍尔木兹甘省班达尔阿巴斯门诊就诊的 CHB 患者。记录了患者的年龄和性别。对所有受试者进行 FibroScan 评估。此外，在 FibroScan 评估后一个月内测量了所有受试者的血液样本中的 AST、ALT 和血小板计数。
结果
本研究共评估了 267 例 CHB 患者（平均年龄：45.45±18.16 岁），其中 173 例（64.8%）为男性。根据 FibroScan 结果，65 例 CHB 患者（24.3%）存在 F1 期纤维化，53 例（19.9%）存在 F2 期纤维化，38 例（14.2%）存在 F3 期纤维化，20 例（7.5%）存在 F4 期纤维化。FibroScan 结果与 AST/ALT 比值、APRI 和 FIB-4 三个指数之间存在显著相关性（P<0.001），其中与 APRI 的相关性最强（r=0.682）。受试者工作特征（ROC）曲线下面积（AUROC）为 0.852（95%置信区间 [CI] 0.807；0.897，P<0.001），APRI≥0.527 对任何程度的肝纤维化具有最佳诊断准确性（77.15%）。尽管 APRI 和 FIB-4 的 AUROC 曲线在鉴别 F3/F4 期和 F0-F2 期肝纤维化方面相似（0.864），但 FIB-4 的诊断准确性最佳（82.02%）。
结论
APRI 可排除 95.4%的 F3/F4 期肝纤维化，可通过 90.78%的 CHB 患者任何程度的肝纤维化。因此，APRI 似乎是评估 CHB 患者肝纤维化的 FibroScan 的最佳替代方法。
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