FIB-4指数与APRI评分在慢加急性乙型肝炎肝衰竭患者预后评估中的价值

Value of FIB-4 Index and APRI Score in Predicting Prognosis of Patients with Acute-on-Chronic Hepatitis B Liver Failure

摘要: 目的：探讨肝纤维化相关评分对慢加急性乙型肝炎肝衰竭(acute-on-chronic hepatitis B liver failure, ACHBLF)患者短期预后的评估价值。方法：回顾性纳入2010年1月至2024年7月于山东大学齐鲁医院肝病科住院并符合纳入与排除标准的261名ACHBLF患者，收集入院24 h内的一般临床资料、FIB-4指数(fibrosis 4 Score, FIB-4)、APRI评分(aspartate aminotransferase to platelet ratio index, APRI)等，根据是否有肝硬化基础分组并进行临床特征比较；探究FIB-4、APRI与临床检验指标的相关性；探究人群FIB-4指数、APRI评分的分布情况；优选指标阈值效应分析确定拐点，进行肝衰竭患者预后分析。结果：FIB-4与天门冬氨酸氨基转移酶(aspartate aminotransferase, AST)、国际标准化比值(international normalized ratio, INR)、终末期肝病模型(model for end-stage liver disease, MELD)呈正相关；与白蛋白(albumin, ALB)、凝血酶原活动度(prothrombin activity, PTA)呈负相关；APRI评分与丙氨酸氨基转移酶(alanine aminotransferase, ALT)、AST、总胆红素(total bilirubin, TBIL)、MELD评分呈正相关；与PTA呈负相关。APRI评分在肝硬化和非肝硬化组ACHBLF患者中无显著性差异(P = 0.551)。选择FIB-4进行阈值效应分析，发现ACHBLF患者预后不良的最佳阈值为11.4。总体ACHBLF中，FIB-4指数 ≥ 11.4的患者28天生存率为43.24%，低于FIB-4 < 11.4的患者28天生存率65.18% (P = 0.011)；FIB-4指数 ≥ 11.4的患者90天生存率为43.24%，低于FIB-4 < 11.4的患者90天生存率63.84% (P = 0.017)；差异有统计学意义(P < 0.05)。合并肝硬化人群中，FIB-4指数 ≥ 11.4的患者28天生存率为45.16%，低于FIB-4 < 11.4的患者28天生存率69.63% (P = 0.010)；FIB-4指数 ≥ 11.4的患者90天生存率为45.16%，低于FIB-4 < 11.4的患者90天生存率67.41% (P = 0.021)，差异有统计学意义(P < 0.05)。结论：在ACHBLF特别是合并肝硬化基础的患者中，FIB-4指数 ≥ 11.4的患者28天和90天的生存率低于FIB-4指数 < 11.4的患者。

Abstract: Objective: To investigate the evaluation value of liver fibrosis-related serum model Fib-4 index and APRI score for the short-term prognosis of acute-on-chronic hepatitis B liver failure (ACHBLF). Methods: A total of 261 ACHBLF patients who were hospitalized in the Department of Hepatology, Qilu Hospital of Shandong University from January 2010 to July 2024 and met the inclusion and exclusion criteria were retrospectively enrolled. General clinical data and fibrosis 4 Score (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) within 24 hours after admission were collected. According to whether there was a basis of liver cirrhosis, the patients were divided into two groups and their clinical characteristics were compared. The correlation between FIB-4, APRI and clinical test index was explored. The distribution of FIB-4 index and APRI score in the population was explored. The distribution of FIB-4 index and APRI score in the population was explored. The threshold effect analysis of the optimal index was used to determine the inflection point and to analyze the prognosis of patients with liver failure. Results: In ACHBLF patients, FIB-4 was positively correlated with aspartate aminotransferase (AST), international normalized ratio (INR) and model for end-stage liver disease (MELD). APRI was negatively correlated with albumin (ALB), prothrombin activity (PTA), systemic immune-inflammatory index (SII), platelet to lymphocyte ratio (PLR) and neutrophil-to-platelet ratio (NPR), and positively correlated with alanine aminotransferase (ALT), AST, total bilirubin (TBIL) and MELD score. It was negatively correlated with PTA, SII and PLR. The distribution of the study population suggested that FIB-4 index (P = 0.013) was more significantly different from APRI score (P = 0.551) in ACHBLF patients with cirrhosis and without cirrhosis. FIB-4 was selected for threshold effect analysis, and the optimal threshold for poor prognosis in ACHBLF patients was 11.4. In all ACHBLF patients, the 28-day survival rate of patients with FIB-4 index ≥ 11.4 was 43.24%, which was lower than 65.18% of patients with FIB-4 index < 11.4 (P = 0.011). The 90-day survival rate of patients with FIB-4 index ≥ 11.4 was 43.24%, which was lower than that of patients with FIB-4 index < 11.4 (63.84%, P = 0.017). The difference was statistically significant (P < 0.05). In patients with liver cirrhosis, the 28-day survival rate of patients with FIB-4 index ≥ 11.4 was 45.16%, which was lower than that of patients with FIB-4 < 11.4 (69.63%, P = 0.010). The 90-day survival rate of patients with FIB-4 index ≥ 11.4 was 45.16%, which was lower than 67.41% of patients with FIB-4 index < 11.4 (P = 0.021). The difference was statistically significant (P < 0.05). Conclusion: The 28-day and 90-day survival rates of patients with FIB-4 index ≥ 11.4 were lower than those with FIB-4 index < 11.4 in all ACHBLF patients and ACHBLF patients with cirrhosis.