CAJ | 학술논문

目的探讨S指数和FIB-4两种新型非创伤性评分系统对慢性乙型肝炎(CHB)患者肝纤维化程度的预测价值,并比较其与传统评分系统APRI和Forns之间的差异.方法收集2006年1月-2011年12月南京医科大学附属第一医院和复旦大学附属华山医院361例CHB确诊患者的临床、实验室检查及病理资料等.根据公式分别计算APRI、Forns、S指数和FIB-4,以肝组织病理学检查作对照,根据受试者工作特征曲线(AUROCs)分别评价四种评分系统对肝纤维化的诊断价值.采用曲线下面积Z检验评价四种评分系统的效率.结果 APRI、Forns、S指数以及FIB-4诊断显著肝纤维化(≥S2)的AUC曲线下面积分别为(0.737±0.027)、(0.716 ±0.028)、(0.745±0.026)和(0.781±0.025),其中FIB-4指数以1.62为界值,诊断显著纤维化的灵敏度、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为59.3％、85.8％、89.4％和51.2％,优于Forns指数(Z=3.28,P=0.001)；而对S4(肝硬化)的AUC曲线下面积分别为(0.687±0.035)、(0.792±0.028)、(0.863±0.024)和(0.832±0.025),其中S指数以1.06为界值,诊断肝硬化的灵敏度、特异性、PPV和NPV分别为77.9％、85.5％、59.4％和93.5％,诊断效率优于APRI和Forns(Z=6.74和3.21,P＜0.01).结论四种评分系统在临床应用中均简单易行,预测结果相对可靠,其中FIB-4和S指数对显著纤维化及肝硬化的预测效果优于APRI和Forns评分,在一定程度上可替代肝组织活检.
목적 탐토S지수화FIB-4량충신형비창상성평분계통대만성을형간염(CHB)환자간섬유화정도적예측개치,병비교기여전통평분계통APRI화Forns지간적차이.방법 수집2006년1월-2011년12월남경의과대학부속제일의원화복단대학부속화산의원361례CHB학진환자적림상、실험실검사급병리자료등.근거공식분별계산APRI、Forns、S지수화FIB-4,이간조직병이학검사작대조,근거수시자공작특정곡선(AUROCs)분별평개사충평분계통대간섬유화적진단개치.채용곡선하면적Z검험평개사충평분계통적효솔.결과 APRI、Forns、S지수이급FIB-4진단현저간섬유화(≥S2)적AUC곡선하면적분별위(0.737±0.027)、(0.716 ±0.028)、(0.745±0.026)화(0.781±0.025),기중FIB-4지수이1.62위계치,진단현저섬유화적령민도、특이성、양성예측치(PPV)화음성예측치(NPV)분별위59.3％、85.8％、89.4％화51.2％,우우Forns지수(Z=3.28,P=0.001)；이대S4(간경화)적AUC곡선하면적분별위(0.687±0.035)、(0.792±0.028)、(0.863±0.024)화(0.832±0.025),기중S지수이1.06위계치,진단간경화적령민도、특이성、PPV화NPV분별위77.9％、85.5％、59.4％화93.5％,진단효솔우우APRI화Forns(Z=6.74화3.21,P＜0.01).결론 사충평분계통재림상응용중균간단역행,예측결과상대가고,기중FIB-4화S지수대현저섬유화급간경화적예측효과우우APRI화Forns평분,재일정정도상가체대간조직활검.
Objective To assess the value of S index and FIB-4 for diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB) by comparing with traditional indexes APRI and Forns.Methods A total of 361 patients with confirmed CHB from the First Hospital of Nanjing Medical University and Huashan Hospital Affiliated to Fudan University during January 2006 and December 2011 were enrolled in the study.The clinical,laboratory and pathological data of patients were collected.Four noninvasive score systems APRI,Forns,S index and FIB-4 were computed.With liver biopsy as the gold standard,the area under the ROC curve (AUROC) was used to assess the value of above 4 score systems in diagnosis of liver fibrosis,and Z test was performed to evaluate the effectiveness of above systems.Results The areas under ROC curve (AUCs) of APRI,Forns,S index and FIB-4 for significant fibrosis (≥S2) were (0.737 ±0.027),(0.716 ± 0.028),(0.745 ± 0.026) and (0.781 ± 0.025),respectively.When the cut off value of FIB-4 was set at 1.62,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) for diagnosis of significant fibrosis were 59.3％,85.8％,89.4％ and 51.2％,respectively,which were better than Forn index (Z =3.28,P =0.001).While for S4 (cirrhosis) the AUCs of APRI,Foms,S index and FIB-4 were (0.687 ± 0.035),(0.792 ± 0.028),(0.863 ± 0.024) and (0.832 ± 0.025),respectively.When the cut off value of S index was set at 1.06,the sensitivity,specificity,PPV and NPV for diagnosis of cirrhosis were 77.9％,85.5％,59.4％ and 93.5％,respectively,which were better than APRI and Forns (Z =6.74 and 3.21,P ＜ 0.01).Conclusions APRI,Forns,S index and FIB-4 are simple and accurate methods for assessing liver fibrosis.FIB-4 and S index are better than APRI and Forns in diagnosis of significant fibrosis and cirrhosis,which may replace liver biopsy in certain extend.