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Diagnostic value of fib-4, aspartate aminotransferaseto-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase

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World Journal of Gastroenterology 2017年第31期23卷 5746-5754页

作者： You-Wen Tan Xing-Bei Zhou Yun Ye Cong He Guo-Hong Ge Department of Hepatology the Third Hospital of Zhenjiang Affiliated Jiangsu University

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 *** 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 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) 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 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.

关键词： Liver stiffness measurement Hepatitis B virus fib-4 Aspartate aminotransferase-to-platelet ratio index Normal Alanine aminotransferase

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Advantages of a Novel Model for Predicting Hepatic fibrosis in Chronic Hepatitis B Virus Carriers Compared with APRI and fib-4 Scores

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Journal of Clinical and Translational Hepatology 2022年第3期10卷 412-419页

作者： Na-Ling Kang Qing-Fa Ruan De-Sheng Zhang Xue-Ping Yu Zhen-Ting Hu Zhi-Min Lin Lu-Ying Wu Meng-Xin Lin Zu-Xiong Huang Jia-Ji Jiang Yu-Rui Liu Ri-Cheng Mao Da-Wu Zeng Department of Hepatology Hepatology Research InstituteThe First Affiliated HospitalFujian Medical UniversityFuzhouFujianChina Hepatology Center Xiamen Hospital of Traditional Chinese MedicineXiamenFujianChina Department of Pharmacy the First Affiliated HospitalFujian Medical UniversityFuzhouFujianChina Department of Infectious Diseases Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency ResponseNational Medical Center for Infectious DiseasesHuashan HospitalFudan UniversityShanghaiChina Department of Infectious Diseases The First Hospital of Quanzhou Affiliated to Fujian Medical UniversityQuanzhouFujianChina Department of Infectious Disease The Affiliated Hospital of Putian CollegePutianFujianChina Department of Gastroenterology The Second Affiliated Hospital of Xiamen Medical CollegeXiamenFujianChina Hepatology Mengchao Hepatobiliary Hospital of Fujian Medical UniversityFuzhouFujianChina

Background and Aims:Aspartate aminotransferase-toplatelet ratio index(APRI)and fibrosis-4 index(fib-4)are widely used to assess liver fibrosis in chronic hepatitis B virus(HBV)***,the definition of normal alanine aminotransferase(ALT)is *** aimed to examine the diagnostic value of APRI and fib-4 in chronic HBV carriers with different upper limits of normal(ULNs)for ***:581 chronic HBV carriers were divided into the following four groups based on different ULNs for ALT:chronic HBV carriers I,II,III,and ***,106 chronic HBV carriers formed an external validation *** values of APRI and fib-4 were elucidated using the area under the curve(AUC).A liver fibrosis-predictive model-GPSA(named for its measure of gamma glutamyl transpeptidase,platelet count,HBsAg and albumin)was developed using multivariate logistic regression ***:In chronic HBV carriers I,the AUCs of APRI and fib-4 were 0.680 and 0.609 for significant fibrosis and 0.678 and 0.661 for cirrhosis,*** AUCs of GPSA for significant fibrosis in the training group,internal group,and external validation group were 0.877,0.837,and 0.871,*** diagnostic value of GPSA differed among chronic HBV carriers I,II,III,and IV,with AUCs for significant fibrosis being 0.857,0.853,0.868,and 0.905 and AUCs for cirrhosis being 0.901,0.905,0.886,and 0.913,*** showed a higher diagnostic value than APRI and fib-4 for predicting significant fibrosis in the four ***:The GPSA model allows for accurate diagnosis of liver fibrosis in chronic HBV carriers with different ULN for ALT.

关键词： APRI fib-4 Liver fibrosis Chronic HBV carriers HBV

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瞬时弹性成像技术、APRI及fib-4对儿童非酒精性脂肪性肝病肝纤维化诊断价值的研究

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中华肝脏病杂志 2022年第1期30卷 81-86页

作者：何舒丽李双杰刘敏欧阳文献陈卫坚郑曦姜涛谭艳芳康桢覃小梅于莹湖南省儿童医院肝病中心长沙410000

目的评估肝脏瞬时弹性成像、天冬氨酸转氨酶与血小板比值指数(APRI)及基于4因子的肝纤维化指数(fib-4)对儿童非酒精性脂肪性肝病(NAFLD)肝纤维化的诊断价值。方法选取湖南省儿童医院2015年8月至2020年10月已行肝穿刺病理活检的非酒精性... 详细信息

目的评估肝脏瞬时弹性成像、天冬氨酸转氨酶与血小板比值指数(APRI)及基于4因子的肝纤维化指数(fib-4)对儿童非酒精性脂肪性肝病(NAFLD)肝纤维化的诊断价值。方法选取湖南省儿童医院2015年8月至2020年10月已行肝穿刺病理活检的非酒精性脂肪性肝病100例进行回顾性研究,收集肝脏病理组织和临床资料。采用受试者操作特征曲线(ROC曲线)分析肝脏硬度(LSM)值、APRI及fib-4诊断儿童NAFLD所致不同肝脏纤维化的诊断价值。结果LSM值、APRI、fib-4诊断肝纤维化(S≥1)的ROC曲线下面积(AUC)分别为0.701[95%可信区间(CI):0.579~0.822,P=0.011]、0.606(95%CI:0.436~0.775,P=0.182)、0.568(95%CI:0.397~0.740,P=0.387),最佳临界值分别为6.65 kPa、21.20、0.18;LSM值、APRI、fib-4诊断显著肝纤维化(S≥2)的AUC分别为0.660(95%CI:0.552~0.768,P=0.006)、0.578(95%CI:0.464~0.691,P=0.182)、0.541(95%CI:0.427~0.655,P=0.482),最佳临界值分别为7.35 kPa、24.78、0.22;LSM值、APRI、fib-4诊断进展期肝纤维化(S≥3)的AUC分别为0.639(95%CI:0.446~0.832,P=0.134)、0.613(95%CI:0.447~0.779,P=0.223)、0.587(95%CI:0.411~0.764,P=0.346),最佳临界值分别为8.55 kPa、26.66、0.27。结论瞬时弹性成像技术对儿童NAFLD肝纤维化有较好的诊断价值,优于APRI和fib-4。

关键词：肝纤维化非酒精性脂肪性肝病诊断弹性成像技术 APRI fib-4

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The combination of endoglin and fib-4 increases the accuracy of detection of hepatic fibrosis in chronic hepatitis C patients

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Open Journal of Gastroenterology 2012年第2期2卷 62-67页

作者： Dawlat Salem Magdy El-Serafy Eman Obeida Wafaa Al-Akel Maissa El-Raziki Dina Attia Mostafa Hassan Biochemistry Department Faculty of Medicine Cairo University Cairo Egypt Endemic Medicine Department Faculty of Medicine Beni-Suef University Beni-Suef Egypt Endemic Medicine Department Faculty of Medicine Cairo University Cairo Egypt

Background and aim: In patients infected with chronic hepatitis C virus, liver biopsy is the gold standard method of staging fibrosis. Different combinations of serum markers attempted to correlate with hepatic fibrosis in place of liver biopsy and have shown encouraging results. The aim of our study is to evaluate the diagnostic value of endoglin and fib-4 as non-invasive markers of hepatic fibrosis in HCV patients. Methods: We estimated serum endoglin & fib-4 index in 40 infected chronic hepatitis C patients. Histological staging of hepatic fibrosis was done according to the METAVIR scoring system. Results: Both endoglin and fib-4 index showed positive correlation with age and aspartate transaminase and inverse correlation with albumin. The diagnostic performance determined by AUROCs for early fibrosis (≤F2), was 0.868 for endoglin and 0.887 for fib-4, at cut off va- lues of 5.5 & 0.98 with sensitivity of 64.3% & 82.1%, and specificity of 100% & 85% respectively. For ad-vanced fibrosis (>F2), the AUROC was 0.98 for endoglin and 0.967 for fib-4, obtained at cut off values of 6.29 & 1.6, with sensitivity of 100% & 91.7%, and specificity of 89.3% & 92.9%, respectively. Conclusion: Both serum endoglin and fib-4 index are fairly accurate in differentiating stages of hepatic fibrosis;their combination in a single equation enhanced the accuracy of fibrosis detection in chronic HCV patients.

关键词： Hepatitis C Virus Hepatic fibrosis Liver Biopsy Non-Invasive Marker Endoglin fib-4

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Comparison between fib-4 Index and fibroscan as Marker of fibrosis in Chronic HCV Infection in Egyptian Patients

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Open Journal of Gastroenterology 2014年第12期4卷 383-391页

作者： Noha A. El Nakeeb Amir Helmy Shereen A. Saleh Heba M. Abdellah Mostafa H. Abdel Aleem Dina Elshennawy Internal Medicine Department Faculty of Medicine Ain Shams University Cairo Egypt Tropical Medicine Department Faculty of Medicine Ain Shams University Cairo Egypt Clinical Pathology Department Faculty of Medicine Ain Shams University Cairo Egypt

The fib-4 index is a simple and noninvasive algorithm consisting to evaluate liver fibrosis in chronic HCV infection. Aim: To evaluate the utility of fib-4 index as a noninvasive marker to assess liver fibrosis in chronic HCV infection in comparison to transient elastography. Patients and Methods: We studied 30 patients having chronic HCV infection based on clinical features, laboratory tests, diagnostics images, fibroscan and fib-4 score. According to the results of fibroscan, the 30 patients were classified into two groups in order to obtain a cutoff value to exclude patient with significant fibrosis: group Ia: 7 patients with no or mild liver fibrosis (F0-F1) and group Ib: 23 pa-tients with significant fibrosis or cirrhosis (F2-F3-F4). Group IIa: 17 patients with no or significant fibrosis (F0-F1-F2-F3) and group IIb (F4): 13 patients with cirrhosis (F4). Results: The mean of fib-4 index increased with the increase of the fibrosis score. fib-4 index proved to be sensitive and specific in differentiation between patients with no or mild fibrosis (F0-F1) and patients with significant fibrosis or cirrhosis (F2-F3-F4) with the best cutoff value at 1.61. It also proved to be sensitive and specific in differentiation between patients with no or significant fibrosis (F0-F1-F2-F3) and patients with cirrhosis (F4) with cutoff value at 1.88. Conclusion: The fib-4 index enabled the correct identification of extreme types of fibrosis. Using these cutoffs (1.61 - 1.88), 87% of patients fell outside these ranges and could thus avoid liverbiopsy with an overall accuracy of 70%.

关键词： Chronic HCV Infection Transient Elastography fib-4 Liver fibrosis Liver Cirrhosis

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RPR fib-4 APRI及AAR对107例慢性乙型肝炎肝纤维化的诊断准确性比较

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中国实用内科杂志 2019年第3期39卷 249-253页

作者：吴方雄闫蓉高保华田秋梅徐静远鲁晓岚西安医学院第一附属医院消化内科陕西西安710077 西安交通大学第二附属医院消化科陕西西安710004 复旦大学附属浦东医院消化内科上海201399

目的分析红细胞分布宽度(red cell distribution width)与血小板比率(RPR)标志物在肝纤维化诊断中的价值及准确性。并与其他已有指数如纤维化-4评分(fibrosis-4 score,fib-4)、天冬氨酸氨基转移酶(AST)/血小板比值指数(AST-to-platelet-... 详细信息

目的分析红细胞分布宽度(red cell distribution width)与血小板比率(RPR)标志物在肝纤维化诊断中的价值及准确性。并与其他已有指数如纤维化-4评分(fibrosis-4 score,fib-4)、天冬氨酸氨基转移酶(AST)/血小板比值指数(AST-to-platelet-ratio-index,APRI)及天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AAR)进行比较。方法2010年1月至2016年12月期间在西安医学院第一附属医院经血清学、病毒学及肝脏组织学表现诊断,且未经抗病毒治疗的慢性乙型肝炎(CHB)患者107例纳入研究,行血液学、生化学、病毒学检查及肝活检术。绘制ROC曲线并计算曲线下面积(AUROC)。结果 RPR诊断F0-1, F2-3及F4的cut-off值分别为0.079, 0.141及0.279(Pfib-4的cut-off值分别为1.194,3.703及4.383 (P4,0.660及1.441(Pfib-4 78.26%,AAR 97.83%及APRI 80.43%;特异度分别为RPR 81.48%,fib-4 75.93%,AAR 14.81%及APRI 80.43%。AUROC分别为RPR 0.787,fib-4 0.778,AAR 0.540及APRI 0.759。总cut-off值分别为RPR 0.11,fib-4 1.94,AAR 0.60及APRI 0.59。结论 RPR, fib-4及APRI对CHB明显纤维化及严重纤维化(硬化)具有较好的诊断准确性及预测价值,其中RPR优于fib-4,而fib-4又优于APRI,因此RPR是一个更好的肝纤维化评估指数。

关键词： RPR fib-4 APRI AAR 纤维化

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Interest of Non-Invasive Markers (APRI, fib-4) for Assessing Hepatic fibrosis in Patients with Chronic Viral Hepatitis B without Cytolysis and with Low Viral Replication

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Open Journal of Gastroenterology 2024年第5期14卷 192-201页

作者： Mamadou Diakité Kouassi Olivier Claver Koffi Amadou Koné Akoun Fabrice Aké Oury Diallo Ahmadou Stellart Jean M. Brou Anassi Jean-Baptiste Okon Department of Medicine and Hepato-Gastroenterology Teaching Hospital of Bouak&#233 Bouak&#233 C&#244te d&#8217Ivoire Faculty of Medical Sciences Alassane Ouattara University Bouak&#233 C&#244te d&#8217Ivoire

Background and Objectives: The indication for treatment in HBsAg-positive patients with low viral load and normal transaminases requires an assessment of fibrosis. In resource-limited settings, free hepatic fibrosis evaluation tests can aid in therapeutic decision-making. Our study aims to demonstrate the utility of assessing hepatic fibrosis using non-invasive markers (APRI and fib-4) in patients with chronic B viral hepatitis without cytolytic activity and low viral replication in our context. Patients and Methods: This is a retrospective cross-sectional study conducted between January 2018 and December 2021 at the University Hospital Center of Bouaké. Included were all patients aged ≥18 with normal transaminases (Results: Our study included 241 patients, with a mean age of 36.19 years (±10.52 years) and a male predominance of 52%. The mean fibroScan® value was 6.44 ± 2.3 kPa, and 68 patients (28.22%) had fibrosis >7 kPa. To exclude significant fibrosis (FS Conclusion: A significant proportion of HBV-infected patients with normal ALT and low viral load have active liver disease. Both fib-4 and APRI biological scores are useful in identifying individuals without significant fibrosis with a good negative predictive value (>50%).

关键词： HBV Infection APRI fib-4 Impulse Elastography BouakéUniversity Hospital

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瞬时弹性成像技术、APRI及fib-4对胆道闭锁患儿肝纤维化程度的诊断价值

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临床肝胆病杂志 2020年第3期36卷 546-550页

作者：陈玮婷李双杰湖南省儿童医院肝病中心长沙410000

目的探讨肝脏瞬时弹性成像技术检测肝脏硬度(LSM)、AST-PLT比值指数(APRI)、基于4因子的肝纤维化指数(fib-4)对胆道闭锁患儿肝纤维化程度的诊断价值。方法选取2016年1月1日-2018年12月31日于湖南省儿童医院新生儿外科行Kasai术的胆道闭... 详细信息

目的探讨肝脏瞬时弹性成像技术检测肝脏硬度(LSM)、AST-PLT比值指数(APRI)、基于4因子的肝纤维化指数(fib-4)对胆道闭锁患儿肝纤维化程度的诊断价值。方法选取2016年1月1日-2018年12月31日于湖南省儿童医院新生儿外科行Kasai术的胆道闭锁患儿110例。收集患儿术中肝脏病理活检标本及术前1周内血常规、肝功能、瞬时弹性成像检查结果。计数资料组间比较采用χ2检验,非正态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验。采用MedCalc软件绘制受试者工作特征曲线(ROC曲线),通过ROC曲线评估瞬时弹性成像技术、APRI和fib-4对胆道闭锁患儿肝纤维化程度的诊断效能。采用Spearman相关法进行相关性分析。结果ROC曲线分析显示,LSM、APRI、fib-4用于判断胆道闭锁明显肝纤维化(F≥2)的临界值分别为9.250 kPa、0.680、0.047,ROC曲线下面积(AUC)分别为0.874[95%可信区间(95%CI):0.778~0.970]、0.636(95%CI:0.362~0.911)、0.622(95%CI:0.363~0.880);LSM、APRI、fib-4用于判断胆道闭锁进展性肝纤维化(F≥3)的临界值分别为10.75 kPa、0.70、0.05,AUC分别为0.781(95%CI:0.689~0.873)、0.519(95%CI:0.401~0.636)、0.506(95%CI:0.389~0.623);LSM、APRI、fib-4用于判断胆道闭锁肝硬化(F≥4)的临界值分别为11.85 kPa、0.82、0.09,AUC分别为0.855(95%CI:0.769~0.942)、0.701(95%CI:0.599~0.803)、0.717(95%CI:0.609~0.825)。相关性分析结果显示,LSM值与AST水平呈正相关(r=0.258,P=0.007),与PLT水平呈负相关(r=-0.248,P=0.009)。结论瞬时弹性成像技术对于胆道闭锁患儿肝纤维化分级具有较高的准确性,其诊断肝纤维化程度的临床价值高于APRI、fib-4。

关键词：胆道闭锁肝硬化弹性成像技术天冬氨酸转氨酶-血小板比值指数 fib-4 诊断

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术前fib-4评分与肝细胞癌术后患者预后的关系研究

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中国肿瘤临床 2017年第10期44卷 498-501页

作者：罗晓勇杜成友阎雄李德卫李明吴乔廖锐重庆市九龙坡区人民医院普外科重庆市400050 重庆医科大学附属第一医院肝胆外科

目的:探讨fib(fibrosis)-4评分系统与肝细胞癌(HCC)患者临床病理特征及预后的关系。方法:收集2009年1月至2012年12月间245例接受根治性肝切除手术的HCC患者的临床及随访资料进行分析,利用Kaplan-Meier进行单因素生存分析,Cox比例风险回... 详细信息

目的:探讨fib(fibrosis)-4评分系统与肝细胞癌(HCC)患者临床病理特征及预后的关系。方法:收集2009年1月至2012年12月间245例接受根治性肝切除手术的HCC患者的临床及随访资料进行分析,利用Kaplan-Meier进行单因素生存分析,Cox比例风险回归模型进行多因素生存分析。结果:根据患者术前fib-4评分,将患者分为fib-4Ⅰ(≤3.25)和fib-4Ⅱ(>3.25)。fib-4能够预测肝硬化程度(Ishak分级:1~5级vs.6级,r=0.681,Pfib-4能够预测HCC患者的预后(总生存时间:P=0.037,0.011;无瘤生存时间:P=0.027,0.043)。结论:fib-4有可能作为HCC根治性切除术后的预后参考指标之一。

关键词：肝细胞癌肝硬化 fib-4 乙型病毒性肝炎预后

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ALBI、NLR、fib-4、MELD评分对血浆置换治疗慢加急性肝衰竭患者短期预后的预测价值

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胃肠病学 2020年第8期25卷 462-466页

作者：章颖明芳徐立新薛红南通市第三人民医院重症感染科 226001

背景:慢加急性肝衰竭(ACLF)病情进展迅速,病死率高,准确预测患者预后能指导制订个体化治疗方案,合理、有效地利用稀缺肝源。目的:探讨ALBI、NLR、fib-4、MELD评分预测行血浆置换(PE)治疗ACLF患者短期预后的价值。方法:回顾性连续收集201... 详细信息

背景:慢加急性肝衰竭(ACLF)病情进展迅速,病死率高,准确预测患者预后能指导制订个体化治疗方案,合理、有效地利用稀缺肝源。目的:探讨ALBI、NLR、fib-4、MELD评分预测行血浆置换(PE)治疗ACLF患者短期预后的价值。方法:回顾性连续收集2015年1月—2019年7月在南通市第三人民医院行PE治疗的ACLF病例,根据入院后第3个月末的生存状态将入选病例分为好转组和恶化组(包括临床恶化、肝移植和死亡病例),采集治疗前实验室指标,计算ALBI、NLR、fib-4、MELD评分。采用多因素logistic回归模型分析预后影响因素,建立联合预测模型。采用ROC曲线评估各单项评分和联合预测模型预测短期预后的效能。结果:共147例ACLF患者纳入研究,好转组71例,恶化组76例。恶化组ALBI、NLR、fib-4、MELD评分均显著高于好转组(P4、0.750和0.860。由logistic回归模型建立的三项联合(ALBI+NLR+fib-4)和四项联合(ALBI+NLR+fib-4+MELD)预测模型的AUC可提高至0.918和0.946。结论:ALBI、NLR、fib-4、MELD评分对预测PE治疗ACLF患者的短期预后具有良好价值,四项联合预测模型预测价值更高。

关键词：慢加急性肝衰竭 ALBI NLR fib-4 MELD 预后 Logistic模型

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