AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal ala...AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase(PNALT).METHODS We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase(PIALT1) group [alanine transaminase(ALT) within 1-2 × upper limit of normal value(ULN)], and 64 in PIALT2 group(ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were performed.RESULTS The pathological examination revealed moderate inflammatory necrosis ratios of 16.81%(16/95), 32.56%(28/86), and 45.31%(28/64), and moderate liverfibrosis of 24.2%(23/95), 33.72%(29/86), and 43.75%(28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group(P < 0.05). No significant difference was found in the areas under the curve(AUCs) between APRI and FIB-4 in the PNALT group; however, significant differences were found between APRI and LSM, and between FIB-4 and LSM in the PNALT group(P < 0.05 for both). In the PIALT1 and PIALT2 groups, no significant difference(P > 0.05) was found in AUCs for all comparisons(P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI(P < 0.05).CONCLUSION APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.展开更多
AIM To evaluate the diagnostic performance of angiotensinconverting enzyme(ACE)on significant liver fibrosis in patients with chronic hepatitis B(CHB). METHODS In total,100 patients with CHB who underwent liver biopsy...AIM To evaluate the diagnostic performance of angiotensinconverting enzyme(ACE)on significant liver fibrosis in patients with chronic hepatitis B(CHB). METHODS In total,100 patients with CHB who underwent liver biopsy in our hospital were enrolled,and 70 patients except for 30 patients with hypertension,fatty liver or habitual alcoholic consumption were analyzed.We compared histological liver fibrosis and serum ACE levels and evaluated the predictive potential to diagnose significant liver fibrosis by comparison with several biochemical marker-based indexes such as the aspartate aminotransferase(AST)-to-platelet ratio index(APRI),the fibrosis index based on four factors(FIB-4),the Mac-2 binding protein glycosylation isomer(M2BPGi)level and the number of platelets(Plt). RESULTS Serum ACE levels showed moderately positive correlation with liver fibrotic stages(R2=0.181).Patients with significant,advanced fibrosis and cirrhosis(F2-4)had significantly higher serum ACE levels than those with early-stage fibrosis and cirrhosis(F0-1).For significant fibrosis(≥F2),the 12.8 U/L cut-off value of ACE showed 91.7%sensitivity and 75.0%specificity.The receiver-operating characteristic(ROC)curves analysis revealed that the area under the curve(AUC)value of ACE was 0.871,which was higher than that of APRI,FIB-4,M2BPGi and Plt. CONCLUSION The serum ACE level could be a novel noninvasive,easy,accurate,and inexpensive marker of significant fibrosis stage in patients with CHB.展开更多
Background and aims:Hepatitis B virus(HBV)infection is a major public health issue worldwide as it may cause serious liver diseases such as cirrhosis and hepatocellular carcinoma(HCC).Ruling out cirrhosis is important...Background and aims:Hepatitis B virus(HBV)infection is a major public health issue worldwide as it may cause serious liver diseases such as cirrhosis and hepatocellular carcinoma(HCC).Ruling out cirrhosis is important when treating chronic hepatitis B(CHB).The aim of this study was to compare the performance of the aspartate aminotransferase-to-platelet ratio index(APRI),fibrosis score based on four factors(FIB-4),and red cell volume distribution width-to-platelet ratio(RPR)in diagnosing liver fibrosis stages and to identify new cut-off values to rule out cirrhosis.Methods:Between 2005 and 2020,2182 eligible individuals who underwent liver biopsy were randomly assigned to derivation and validation cohorts in a 6:4 ratio.A grid search was applied to identify optimal cut-off values with a sensitivity of>90% and a negative predictive value(NPV)of at least 95%.Results:Overall,1309 individuals(175 patients with cirrhosis)were included in the derivation dataset,and 873(117 patients with cirrhosis)were included in the validation cohort.The area under the receiver operating characteristic curve of RPR for diagnosing cirrhosis was 0.821,which was comparable to that of APRI(0.818,P=0.7905)and FIB-4(0.803,P=0.2395).When applying an RPR of 0.06,cirrhosis was correctly identified with a sensitivity of 93.1% and an NPV of 97.1%,while it misclassified 12 of 175(6.9%)patients in the derivation cohort.In the validation cohort,RPR had a sensitivity and NPV of 97.4% and 99.0%,respectively,and only misclassified 3 of 117(2.6%)patients.Subgroup analysis indicated that the new RPR cut-off value performed more consistently than that of APRI and FIB-4 in all subgroups.Conclusion:A recently established cut-off value for RPR(≤0.06)was validated and was more effective than APRI and FIB-4 in excluding patients with cirrhosis due to a higher sensitivity and NPV and a lower misclassification rate.This simple and dependable test could have significant clinical implications in identifying patients who require monitoring for portal hypertensio展开更多
Background and aims.Non-alcoholic fatty liver disease(NAFLD)is a common,morbid disease with profound implications for the overall health of the patient.We set out to determine the clinical predictors of advanced histo...Background and aims.Non-alcoholic fatty liver disease(NAFLD)is a common,morbid disease with profound implications for the overall health of the patient.We set out to determine the clinical predictors of advanced histology in the referral population.Methods.We performed a retrospective review of all biopsy-proven NAFLD patients,including 358 unique patients first seen between 1996 and 2009.Liver histology and ultrasound images were reviewed prospectively by clinicians who were blinded to clinical information and test indication.Results.Compared with men,women tended to present at an older age(51.4-10.6 vs 45.3-11.2 years,P<0.001),were more likely to be Caucasian(P=0.003),less likely to present with an elevated alanine aminotransferase(ALT)(75.2%vs 88.8%),and more likely to have advanced non-alcoholic steatohepatitis(NASH)(44.7%vs 29.9%;P=0.04)and advanced fibrosis(23.3%vs 14.1%;P=0.03).In multivariate logistic regression,body mass index(BMI)-30 kg/m^(2)(odds ratio(OR)2.21;95%confidential interval(CI):1.23–4.08),female gender(OR 1.76;95%CI:1.01–3.10)and aspartate aminotransferase(AST)>40 IU/L(OR 2.00;95%CI:1.14–3.55)were associated with a NAFLD activity score>4.The sensitivity and specificity of an AST to platelet ratio index(APRI)>1 for significant fibrosis was 30.0%(95%CI:17.2–45.4%)and 92.8%(95%CI:88.2-95.8%),respectively;the likelihood ratio is 4.2.In multivariate logistic regression,APRI>1 was the most significant predictor of advanced fibrosis(OR 3.85;95%CI:1.55–9.59).In patients without ultrasound-detected steatosis,20%had advanced fibrosis and 16.7%had active NASH.Conclusion.Patients with suspected NAFLD should routinely be evaluated for advanced liver disease,including non-invasive indices of fibrosis such as APRI,and serious consideration given to liver biopsy.展开更多
目的探讨肝功能检查和门冬氨酸氨基转移酶／血小板指数（aspartate aminotr-ans—ferase-to-platelet ratio index，APRI）与肝脏纤维化程度的关系，阐述其在BA肝纤维化评估中的临床价值。方法收集2006年2月至2011年8月间在我院治疗的...目的探讨肝功能检查和门冬氨酸氨基转移酶／血小板指数（aspartate aminotr-ans—ferase-to-platelet ratio index，APRI）与肝脏纤维化程度的关系，阐述其在BA肝纤维化评估中的临床价值。方法收集2006年2月至2011年8月间在我院治疗的胆道闭锁患儿38例和胆汁淤积综合征患儿25例为研究对象。临床观察指标包括肝功能检查，肝脏活检切片，血小板指数；肝硬化程度采用Metavir分类，APRI的诊断陛评估采用ROC曲线，应用SPSS16．O统计学软件进行统计分析。并对本组患儿进行随访，随访时间是3～69个月（平均随访时间：20．7个月）。结果胆道闭锁组患儿ALP、γ-GT、DBIL（564．14±257．75、153．36±97．47、7．55±2．57）较胆汁淤积综合征组患儿存在明显升高（P〈0．05）；胆道闭锁肝硬化组患儿Age、ALT、AST、γ-GT（84．50±24．72、225．07±109．68、331．64±130．93、951．07±667．24）较非肝硬化组明显升高，两组差异具有统计学意义（P〈0．05）；胆汁淤积综合征肝纤维化组患儿Age、ALT、AST（84．76±14．28、159．92±61．76、238．15±62．60）较非肝纤维化组（54．17±11．17、98．92±58．08、151．17±41．44）明显升高，两组差异具有统计学意义（P〈0．05）。患儿绘制APRI的ROC曲线，用于判定肝硬化程度，胆道闭锁组敏感性为79％，特异性为88％；胆汁淤积综合征组敏感性为91％，特异性为79％。胆道闭锁中肝硬化组病死率显著高于非肝硬化组，且自体肝生存情况低于非肝硬化组。结论肝功能检查可以作为胆道闭锁的初步判断指标，绘制APRI的ROC曲线对于评价胆道闭锁及胆汁淤积综合征患儿的肝脏纤维化情况均有较高准确性和可靠性，可用于预测预后和提早做好肝移植准备，因其简单、无创性可以在临床上广泛应用。展开更多
目的检测慢性HBV感染患者天门冬氨酸氨基转移酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)、基于4因子的纤维化指数(fibrosis index based on the four factors,FIB-4)的数值的变化,分析评估肝功能状...目的检测慢性HBV感染患者天门冬氨酸氨基转移酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)、基于4因子的纤维化指数(fibrosis index based on the four factors,FIB-4)的数值的变化,分析评估肝功能状态,并探讨临床意义,以便寻求简单易行的肝纤维化无创诊断手段。方法采用临床对照的研究方法,选取青岛大学医学院第二附属医院2016年1月至2017年6月期间门诊和住院的120例不同临床感染状态下的慢性HBV感染患者,分为HBV携带者、慢性乙型肝炎患者以及乙型肝炎肝硬化患者3组,每组40例,检测血清总胆红素、白蛋白、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)和血小板的含量,根据公式计算出APRI和FIB-4的数值,研究其在不同类型慢性HBV感染患者的数值变化。并与总胆红素、白蛋白之间作相关性分析。同时选取30名健康者作为健康对照组进行对照分析。结果慢性HBV感染患者、健康对照组APRI的数值分别为1.17±0.71与0.50±0.23,慢性HBV感染患者、健康对照组FIB-4的数值分别为1.90±0.84与1.08±0.58,差异均有统计学意义(P均<0.01)。HBV携带者组、慢性乙型肝炎组、乙型肝炎肝硬化组患者APRI的数值分别为0.53±0.22、1.14±0.61、1.84±0.49;FIB-4的数值分别为1.22±0.54、1.85±0.48、2.64±0.77。慢性HBV感染各亚组患者APRI、FIB-4的数值,随着肝纤维化程度的的升高而递增,组间比较差异均有统计学意义(P均<0.01);其中乙型肝炎肝硬化组与健康对照组、慢性乙型肝炎组与健康对照组、乙型肝炎肝硬化组与HBV携带者组、慢性乙型肝炎组与HBV携带者组比较差异有统计学意义(P<0.01)。HBV携带者组与健康对照组比较差异无统计学意义(P>0.05)。相关性分析结果显示,慢性HBV感染患者APRI、FIB-4与总胆红素呈正相关性(P均<0.01);与白蛋白呈负相关性(P均<0.01)�展开更多
目的:探讨aMAP(age-male-ALBI-platelet,aMAP)、天门冬氨酸氨基转移酶/血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)、基于4因子的肝纤维化指数(fibrosis index based on the 4 factors,FIB-4)及肝硬度值(...目的:探讨aMAP(age-male-ALBI-platelet,aMAP)、天门冬氨酸氨基转移酶/血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)、基于4因子的肝纤维化指数(fibrosis index based on the 4 factors,FIB-4)及肝硬度值(liver stiffness measurement,LSM)评估乙型肝炎(乙肝)肝硬化患者食管胃静脉曲张(esophageal gastric varices,EGV)程度的价值。方法:选取2018年4月到2022年5月期间在上海交通大学医学院附属瑞金医院确诊并接受治疗的乙肝肝硬化患者114例,对其进行肝功能、血常规、LSM、胃镜等检查,根据计算公式计算aMAP、APRI、FIB-4。根据胃镜结果将患者分为无EGV组(39例)、轻度EGV组(30例)、中度EGV组(23例)及重度EGV组(22例),比较4组间的aMAP、APRI、FIB-4。采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析aMAP、APRI、FIB-4及LSM评估乙肝肝硬化患者EGV程度的价值。结果:EGV患者(包括轻度、中度及重度EGV组)的aMAP、APRI、FIB-4、LSM均显著高于无EGV的患者,差异有统计学意义(P<0.05)。轻度、中度及重度EGV组间的aMAP、APRI、FIB-4差异均有统计学意义(P<0.05);轻度EGV组与中度、重度EGV组间LSM差异有统计学意义(P<0.05)。aMAP评估EGV程度的ROC曲线下面积(the area under ROC curve,AUROC)为0.76,灵敏度为85.9%,特异度为65.7%;APRI、FIB-4和LSM评估EGV程度的AUROC分别为0.86、0.85、0.79,灵敏度分别为81.30%、82.80%、88.40%,特异度分别为82.90%、77.10%、66.80%。aMAP、APRI、FIB-4和LSM对肝硬化患者是否合并EGV有较好诊断价值(P<0.05)。aMAP、APRI、FIB-4对乙肝肝硬化患者的EGV程度有一定诊断价值(P<0.05),但特异度较低。结论:aMAP、APRI、FIB-4及LSM诊断乙肝肝硬化患者伴EGV的价值较高,而aMAP、APRI及FIB-4对其EGV程度有一定评估价值,可作为不适合做胃镜患者评估EGV的补充参考,为EGV的预防及治疗提供依据。展开更多
目的探讨声触诊弹性成像(STE)、声触诊弹性测量(STQ)及天门冬氨酸氨基转移酶与血小板比率指数(APRI)、基于4因子的纤维化指数(fibrosis index based on the four factors,FIB-4指数)对慢性肝病纤维化的诊断效能及与病理的相关性。方法选...目的探讨声触诊弹性成像(STE)、声触诊弹性测量(STQ)及天门冬氨酸氨基转移酶与血小板比率指数(APRI)、基于4因子的纤维化指数(fibrosis index based on the four factors,FIB-4指数)对慢性肝病纤维化的诊断效能及与病理的相关性。方法选取2018年8月至2022年2月昆明市第一人民医院收治的符合研究条件的患者80例,行肝脏穿刺活检,穿刺前行STE、STQ检查得出肝硬度值(LSM_(STE)、LSM_(STQ))中位数,收集肝穿刺活检前7 d内的血清学指标,计算APRI和FIB-4,与肝脏穿刺活检病理结果对照,以病理结果为“金标准”,绘制F2期、F3期、F4期的LSM_(STE)、LSM_(STQ)和APRI、FIB-4诊断肝纤维化的受试者工作特征曲线(ROC),并计算曲线下面积(AUC)及各期敏感度、特异度,AUC采用Delong法进行比较。应用Spearman相关系数评估LSM_(STE)、LSM_(STQ)、APRI、FIB-4与病理分期之间的相关性。结果LSM_(STE)、LSM_(STQ)、APRI和FIB-4诊断慢性肝病肝纤维化的AUC分别为0.863、0.840、0.693、0.805;AUC比较发现,F2期、F3期、F4期LSM_(STE)、LSM_(STQ)诊断效能相当(P>0.05);F2期、F4期LSM_(STE)、LSM_(STQ)均优于APRI(P<0.05),与FIB-4诊断效能相当(P>0.05);F3期LSM_(STE)、LSM_(STQ)、FIB-4优于APRI(P<0.05)。LSM_(STE)诊断肝纤维化F2期、F3期、F4期的敏感度分别为80.0%、63.2%、81.3%,特异度分别为80.0%、83.3%、82.8%;LSM_(STQ)诊断肝纤维化F2期、F3期、F4期的敏感度分别为71.7%、76.3%、75.0%,特异度分别为90.0%、69.0%、93.7%。相关性分析结果显示,LSM_(STE)、LSM_(STQ)、FIB-4及APRI与肝纤维化程度分别呈正相关(r=0.630、0.646、0.470、0.293,P<0.05)。结论LSM_(STE)、LSM_(STQ)、APRI及FIB-4均可用于临床评估慢性肝病肝纤维化程度,但剪切波弹性成像LSM_(STE)、LSM_(STQ)诊断效能明显优于血清学诊断模型APRI、FIB-4。展开更多
目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检...目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检测,并分析APRI、血氨值与HE之间的关系。结果伴有HE患者的Child分级和MELD评分均高于无HE者,差异有统计学意义(P<0.05)。APRI值在HE组的值为4.38±2.68,高于无HE组的2.19±1.75,差异有统计学意义(t=-4.721,P<0.001)。APRI值在不同HE分级中的分布:1级3.70±0.55、2级5.30±0.43、3~4级5.75±1.27,1级<2级<3~4级,差异有统计学意义(H=6.704,P=0.035)。血氨值在不同HE分级中的分布:1级(108.0±6.1)μg/dl、2级(130.4±23.4)μg/dl、3~4级(170.5±12.5)μg/dl,1级<2级<3~4级,差异有统计学意义(H=10.95,P=0.004)。APRI与血氨联合诊断HE时,ROC曲线下面积为0.898,敏感度为91.8%,特异度为96.9%。结论 APRI和血氨联合检测诊断HE效能较高,具有较好的临床应用价值。展开更多
文摘AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase(PNALT).METHODS We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase(PIALT1) group [alanine transaminase(ALT) within 1-2 × upper limit of normal value(ULN)], and 64 in PIALT2 group(ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were performed.RESULTS The pathological examination revealed moderate inflammatory necrosis ratios of 16.81%(16/95), 32.56%(28/86), and 45.31%(28/64), and moderate liverfibrosis of 24.2%(23/95), 33.72%(29/86), and 43.75%(28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group(P < 0.05). No significant difference was found in the areas under the curve(AUCs) between APRI and FIB-4 in the PNALT group; however, significant differences were found between APRI and LSM, and between FIB-4 and LSM in the PNALT group(P < 0.05 for both). In the PIALT1 and PIALT2 groups, no significant difference(P > 0.05) was found in AUCs for all comparisons(P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI(P < 0.05).CONCLUSION APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.
文摘AIM To evaluate the diagnostic performance of angiotensinconverting enzyme(ACE)on significant liver fibrosis in patients with chronic hepatitis B(CHB). METHODS In total,100 patients with CHB who underwent liver biopsy in our hospital were enrolled,and 70 patients except for 30 patients with hypertension,fatty liver or habitual alcoholic consumption were analyzed.We compared histological liver fibrosis and serum ACE levels and evaluated the predictive potential to diagnose significant liver fibrosis by comparison with several biochemical marker-based indexes such as the aspartate aminotransferase(AST)-to-platelet ratio index(APRI),the fibrosis index based on four factors(FIB-4),the Mac-2 binding protein glycosylation isomer(M2BPGi)level and the number of platelets(Plt). RESULTS Serum ACE levels showed moderately positive correlation with liver fibrotic stages(R2=0.181).Patients with significant,advanced fibrosis and cirrhosis(F2-4)had significantly higher serum ACE levels than those with early-stage fibrosis and cirrhosis(F0-1).For significant fibrosis(≥F2),the 12.8 U/L cut-off value of ACE showed 91.7%sensitivity and 75.0%specificity.The receiver-operating characteristic(ROC)curves analysis revealed that the area under the curve(AUC)value of ACE was 0.871,which was higher than that of APRI,FIB-4,M2BPGi and Plt. CONCLUSION The serum ACE level could be a novel noninvasive,easy,accurate,and inexpensive marker of significant fibrosis stage in patients with CHB.
基金supported by grants from the Natural Science Foundation of Guangdong Province for Distinguished Young Scholar(2022B1515020024)the National Natural Science Foundation of China(82070574)the Natural Science Foundation Team Project of Guangdong Province(2018B030312009).
文摘Background and aims:Hepatitis B virus(HBV)infection is a major public health issue worldwide as it may cause serious liver diseases such as cirrhosis and hepatocellular carcinoma(HCC).Ruling out cirrhosis is important when treating chronic hepatitis B(CHB).The aim of this study was to compare the performance of the aspartate aminotransferase-to-platelet ratio index(APRI),fibrosis score based on four factors(FIB-4),and red cell volume distribution width-to-platelet ratio(RPR)in diagnosing liver fibrosis stages and to identify new cut-off values to rule out cirrhosis.Methods:Between 2005 and 2020,2182 eligible individuals who underwent liver biopsy were randomly assigned to derivation and validation cohorts in a 6:4 ratio.A grid search was applied to identify optimal cut-off values with a sensitivity of>90% and a negative predictive value(NPV)of at least 95%.Results:Overall,1309 individuals(175 patients with cirrhosis)were included in the derivation dataset,and 873(117 patients with cirrhosis)were included in the validation cohort.The area under the receiver operating characteristic curve of RPR for diagnosing cirrhosis was 0.821,which was comparable to that of APRI(0.818,P=0.7905)and FIB-4(0.803,P=0.2395).When applying an RPR of 0.06,cirrhosis was correctly identified with a sensitivity of 93.1% and an NPV of 97.1%,while it misclassified 12 of 175(6.9%)patients in the derivation cohort.In the validation cohort,RPR had a sensitivity and NPV of 97.4% and 99.0%,respectively,and only misclassified 3 of 117(2.6%)patients.Subgroup analysis indicated that the new RPR cut-off value performed more consistently than that of APRI and FIB-4 in all subgroups.Conclusion:A recently established cut-off value for RPR(≤0.06)was validated and was more effective than APRI and FIB-4 in excluding patients with cirrhosis due to a higher sensitivity and NPV and a lower misclassification rate.This simple and dependable test could have significant clinical implications in identifying patients who require monitoring for portal hypertensio
文摘Background and aims.Non-alcoholic fatty liver disease(NAFLD)is a common,morbid disease with profound implications for the overall health of the patient.We set out to determine the clinical predictors of advanced histology in the referral population.Methods.We performed a retrospective review of all biopsy-proven NAFLD patients,including 358 unique patients first seen between 1996 and 2009.Liver histology and ultrasound images were reviewed prospectively by clinicians who were blinded to clinical information and test indication.Results.Compared with men,women tended to present at an older age(51.4-10.6 vs 45.3-11.2 years,P<0.001),were more likely to be Caucasian(P=0.003),less likely to present with an elevated alanine aminotransferase(ALT)(75.2%vs 88.8%),and more likely to have advanced non-alcoholic steatohepatitis(NASH)(44.7%vs 29.9%;P=0.04)and advanced fibrosis(23.3%vs 14.1%;P=0.03).In multivariate logistic regression,body mass index(BMI)-30 kg/m^(2)(odds ratio(OR)2.21;95%confidential interval(CI):1.23–4.08),female gender(OR 1.76;95%CI:1.01–3.10)and aspartate aminotransferase(AST)>40 IU/L(OR 2.00;95%CI:1.14–3.55)were associated with a NAFLD activity score>4.The sensitivity and specificity of an AST to platelet ratio index(APRI)>1 for significant fibrosis was 30.0%(95%CI:17.2–45.4%)and 92.8%(95%CI:88.2-95.8%),respectively;the likelihood ratio is 4.2.In multivariate logistic regression,APRI>1 was the most significant predictor of advanced fibrosis(OR 3.85;95%CI:1.55–9.59).In patients without ultrasound-detected steatosis,20%had advanced fibrosis and 16.7%had active NASH.Conclusion.Patients with suspected NAFLD should routinely be evaluated for advanced liver disease,including non-invasive indices of fibrosis such as APRI,and serious consideration given to liver biopsy.
文摘目的探讨肝功能检查和门冬氨酸氨基转移酶／血小板指数（aspartate aminotr-ans—ferase-to-platelet ratio index，APRI）与肝脏纤维化程度的关系，阐述其在BA肝纤维化评估中的临床价值。方法收集2006年2月至2011年8月间在我院治疗的胆道闭锁患儿38例和胆汁淤积综合征患儿25例为研究对象。临床观察指标包括肝功能检查，肝脏活检切片，血小板指数；肝硬化程度采用Metavir分类，APRI的诊断陛评估采用ROC曲线，应用SPSS16．O统计学软件进行统计分析。并对本组患儿进行随访，随访时间是3～69个月（平均随访时间：20．7个月）。结果胆道闭锁组患儿ALP、γ-GT、DBIL（564．14±257．75、153．36±97．47、7．55±2．57）较胆汁淤积综合征组患儿存在明显升高（P〈0．05）；胆道闭锁肝硬化组患儿Age、ALT、AST、γ-GT（84．50±24．72、225．07±109．68、331．64±130．93、951．07±667．24）较非肝硬化组明显升高，两组差异具有统计学意义（P〈0．05）；胆汁淤积综合征肝纤维化组患儿Age、ALT、AST（84．76±14．28、159．92±61．76、238．15±62．60）较非肝纤维化组（54．17±11．17、98．92±58．08、151．17±41．44）明显升高，两组差异具有统计学意义（P〈0．05）。患儿绘制APRI的ROC曲线，用于判定肝硬化程度，胆道闭锁组敏感性为79％，特异性为88％；胆汁淤积综合征组敏感性为91％，特异性为79％。胆道闭锁中肝硬化组病死率显著高于非肝硬化组，且自体肝生存情况低于非肝硬化组。结论肝功能检查可以作为胆道闭锁的初步判断指标，绘制APRI的ROC曲线对于评价胆道闭锁及胆汁淤积综合征患儿的肝脏纤维化情况均有较高准确性和可靠性，可用于预测预后和提早做好肝移植准备，因其简单、无创性可以在临床上广泛应用。
文摘目的检测慢性HBV感染患者天门冬氨酸氨基转移酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)、基于4因子的纤维化指数(fibrosis index based on the four factors,FIB-4)的数值的变化,分析评估肝功能状态,并探讨临床意义,以便寻求简单易行的肝纤维化无创诊断手段。方法采用临床对照的研究方法,选取青岛大学医学院第二附属医院2016年1月至2017年6月期间门诊和住院的120例不同临床感染状态下的慢性HBV感染患者,分为HBV携带者、慢性乙型肝炎患者以及乙型肝炎肝硬化患者3组,每组40例,检测血清总胆红素、白蛋白、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)和血小板的含量,根据公式计算出APRI和FIB-4的数值,研究其在不同类型慢性HBV感染患者的数值变化。并与总胆红素、白蛋白之间作相关性分析。同时选取30名健康者作为健康对照组进行对照分析。结果慢性HBV感染患者、健康对照组APRI的数值分别为1.17±0.71与0.50±0.23,慢性HBV感染患者、健康对照组FIB-4的数值分别为1.90±0.84与1.08±0.58,差异均有统计学意义(P均<0.01)。HBV携带者组、慢性乙型肝炎组、乙型肝炎肝硬化组患者APRI的数值分别为0.53±0.22、1.14±0.61、1.84±0.49;FIB-4的数值分别为1.22±0.54、1.85±0.48、2.64±0.77。慢性HBV感染各亚组患者APRI、FIB-4的数值,随着肝纤维化程度的的升高而递增,组间比较差异均有统计学意义(P均<0.01);其中乙型肝炎肝硬化组与健康对照组、慢性乙型肝炎组与健康对照组、乙型肝炎肝硬化组与HBV携带者组、慢性乙型肝炎组与HBV携带者组比较差异有统计学意义(P<0.01)。HBV携带者组与健康对照组比较差异无统计学意义(P>0.05)。相关性分析结果显示,慢性HBV感染患者APRI、FIB-4与总胆红素呈正相关性(P均<0.01);与白蛋白呈负相关性(P均<0.01)�
文摘目的:探讨aMAP(age-male-ALBI-platelet,aMAP)、天门冬氨酸氨基转移酶/血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)、基于4因子的肝纤维化指数(fibrosis index based on the 4 factors,FIB-4)及肝硬度值(liver stiffness measurement,LSM)评估乙型肝炎(乙肝)肝硬化患者食管胃静脉曲张(esophageal gastric varices,EGV)程度的价值。方法:选取2018年4月到2022年5月期间在上海交通大学医学院附属瑞金医院确诊并接受治疗的乙肝肝硬化患者114例,对其进行肝功能、血常规、LSM、胃镜等检查,根据计算公式计算aMAP、APRI、FIB-4。根据胃镜结果将患者分为无EGV组(39例)、轻度EGV组(30例)、中度EGV组(23例)及重度EGV组(22例),比较4组间的aMAP、APRI、FIB-4。采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析aMAP、APRI、FIB-4及LSM评估乙肝肝硬化患者EGV程度的价值。结果:EGV患者(包括轻度、中度及重度EGV组)的aMAP、APRI、FIB-4、LSM均显著高于无EGV的患者,差异有统计学意义(P<0.05)。轻度、中度及重度EGV组间的aMAP、APRI、FIB-4差异均有统计学意义(P<0.05);轻度EGV组与中度、重度EGV组间LSM差异有统计学意义(P<0.05)。aMAP评估EGV程度的ROC曲线下面积(the area under ROC curve,AUROC)为0.76,灵敏度为85.9%,特异度为65.7%;APRI、FIB-4和LSM评估EGV程度的AUROC分别为0.86、0.85、0.79,灵敏度分别为81.30%、82.80%、88.40%,特异度分别为82.90%、77.10%、66.80%。aMAP、APRI、FIB-4和LSM对肝硬化患者是否合并EGV有较好诊断价值(P<0.05)。aMAP、APRI、FIB-4对乙肝肝硬化患者的EGV程度有一定诊断价值(P<0.05),但特异度较低。结论:aMAP、APRI、FIB-4及LSM诊断乙肝肝硬化患者伴EGV的价值较高,而aMAP、APRI及FIB-4对其EGV程度有一定评估价值,可作为不适合做胃镜患者评估EGV的补充参考,为EGV的预防及治疗提供依据。
文摘目的探讨声触诊弹性成像(STE)、声触诊弹性测量(STQ)及天门冬氨酸氨基转移酶与血小板比率指数(APRI)、基于4因子的纤维化指数(fibrosis index based on the four factors,FIB-4指数)对慢性肝病纤维化的诊断效能及与病理的相关性。方法选取2018年8月至2022年2月昆明市第一人民医院收治的符合研究条件的患者80例,行肝脏穿刺活检,穿刺前行STE、STQ检查得出肝硬度值(LSM_(STE)、LSM_(STQ))中位数,收集肝穿刺活检前7 d内的血清学指标,计算APRI和FIB-4,与肝脏穿刺活检病理结果对照,以病理结果为“金标准”,绘制F2期、F3期、F4期的LSM_(STE)、LSM_(STQ)和APRI、FIB-4诊断肝纤维化的受试者工作特征曲线(ROC),并计算曲线下面积(AUC)及各期敏感度、特异度,AUC采用Delong法进行比较。应用Spearman相关系数评估LSM_(STE)、LSM_(STQ)、APRI、FIB-4与病理分期之间的相关性。结果LSM_(STE)、LSM_(STQ)、APRI和FIB-4诊断慢性肝病肝纤维化的AUC分别为0.863、0.840、0.693、0.805;AUC比较发现,F2期、F3期、F4期LSM_(STE)、LSM_(STQ)诊断效能相当(P>0.05);F2期、F4期LSM_(STE)、LSM_(STQ)均优于APRI(P<0.05),与FIB-4诊断效能相当(P>0.05);F3期LSM_(STE)、LSM_(STQ)、FIB-4优于APRI(P<0.05)。LSM_(STE)诊断肝纤维化F2期、F3期、F4期的敏感度分别为80.0%、63.2%、81.3%,特异度分别为80.0%、83.3%、82.8%;LSM_(STQ)诊断肝纤维化F2期、F3期、F4期的敏感度分别为71.7%、76.3%、75.0%,特异度分别为90.0%、69.0%、93.7%。相关性分析结果显示,LSM_(STE)、LSM_(STQ)、FIB-4及APRI与肝纤维化程度分别呈正相关(r=0.630、0.646、0.470、0.293,P<0.05)。结论LSM_(STE)、LSM_(STQ)、APRI及FIB-4均可用于临床评估慢性肝病肝纤维化程度,但剪切波弹性成像LSM_(STE)、LSM_(STQ)诊断效能明显优于血清学诊断模型APRI、FIB-4。
