APRI、FIB-4、RPR和GPR在慢性HBV感染诊断中的意义

Significance of APRI, FIB-4, RPR and GPR in the Diagnosis of Chronic HBV Infection

摘要: 目的：观察慢性乙型肝炎病毒(hepatitis B virus, HBV)感染自然史不同阶段血清天冬氨酸转氨酶和血小板比率指数(APRI)、肝纤维化4因子指数(FIB-4)、红细胞体积分布宽度–血小板比值(RPR)和γ-谷氨酰转肽酶–血小板比值(GPR)的变化，研究其在慢性HBV感染诊断中的意义。方法收集：2018年~2020年青岛大学附属医院、青岛传染病医院确诊的未经抗病毒治疗的慢性HBV感染肝炎患者292例及肝硬化患者88例。根据《慢性乙型肝炎防治指南》中HBV感染的自然史划分标准将慢性HBV感染肝炎患者分为4组：免疫耐受期、免疫清除期、免疫控制期和再活动期。患者均行血常规、生化学、病毒学及影像学检查，计算APRI、FIB-4、GPR和RPR指数，对APRI、FIB-4、GPR和RPR四种无创诊断模型与慢性HBV感染疾病进展的相关性检验进行Spearman相关分析，采用受试者工作曲线(ROC曲线))评估APRI、FIB-4、GPR和RPR指数对慢性HBV感染病程的诊断价值。结果：APRI、FIB-4、GPR、RPR指数与HBV感染疾病进程呈正相关，相关系数分别是0.306、0.433、0.133、0.439，P均 < 0.05。其中APRI在诊断免疫清除期及再活动期时的曲线下面积最高，ARROC分别为0.939、0.956。在诊断肝硬化时FIB-4的曲线下面积高于APRI，AUROC分别为0.817。结论：APRI和FIB-4对慢性HBV感染者病程分期具有较好的诊断价值，APRI值及FIB-4可作为无创性评估HBV感染疾病进展的优选指标，但不能代替肝活检检查。

Abstract: Aim: To observe the changes of serum aspartate aminotransferase and platelet ratio index (APRI), liver fibrosis factor 4 index (FIB-4), red blood cell volume distribution width platelet ratio (RPR) and gamma glutamyl transpeptidase platelet ratio (GPR) in different stages of the natural history of chronic hepatitis B virus infection. Methods: From 2013 to 2020, 292 patients with chronic HBV infection and 88 patients with liver cirrhosis who were diagnosed in Qingdao University Hospital and Qingdao Infectious Disease Hospital without antiviral treatment were collected. According to the natural history classification criteria of HBV infection in the “Guidelines for the Prevention and Treatment of Chronic Hepatitis B”: Patients with chronic HBV infection are divided into 4 groups: immune tolerance period, immune clearance period, immune control period and reactivation period. All patients underwent blood routine, biochemical, virological and imaging examinations, and calculated APRI, FIB-4, GPR and RPR indexes. The four non-invasive diagnostic models of APRI, FIB-4, GPR and RPR and the progression of chronic HBV infection Correlation test Spearman correlation analysis was performed, and receiver operating curve (ROC curve) was used to evaluate the diagnostic value of APRI, FIB-4, GPR and RPR indexes for the course of chronic HBV infection. Results APRI, FIB-4, GPR, RPR indexes were positively correlated with the progression of HBV infection, the correlation coefficients were 0.306, 0.433, 0.133, 0.439, all P < 0.05. Among them, APRI has the highest area under the curve in the diagnosis of immune clearance and reactivation, which are 0.939 and 0.956 respectively. In diagnosing liver cirrhosis, FIB-4 is higher than APRI, AUROC is 0.817. Conclusion APRI and FIB-4 have good diagnostic value for the stage of chronic HBV infection. APRI and FIB-4 can be used as preferred indicators for non-invasive assessment of the progression of HBV infection, but they cannot replace liver biopsy.