【摘要】 目的 比较FIB-4和APRI在慢性HBV感染者晚期肝纤维化和疾病进展中的预测效能。方法 纳入2013年2月—2022年12月在广西医科大学第一附属医院感染科进行肝穿刺的慢性HBV感染者497例，其中回顾性研究404例，前瞻性研究75例。收集患者基线人口统计学特征（性别、年龄）、生化指标（ALT、AST）、血小板计数等指标，并计算FIB-4和APRI。非正态分布的计量资料两组间比较采用Mann-Whitney U检验，多组间数据比较采用Kruskal-Wallis H检验；计数资料组间比较采用χ~2检验。采用ROC曲线下面积（AUC）分析评估APRI和FIB-4预测慢性HBV感染者肝纤维化程度和疾病进展的能力。结果 在回顾性分析中，与FIB-4<2.67相比，FIB-4在高范围值（≥2.67）诊断为肝硬化和肝细胞癌的患者占比较高（66.19%vs47.54%，χ~2=12.75,P<0.001）。FIB-4和APRI在F0～F4期的中位值随着肝纤维化程度增加而增加，差异有统计学意义（H值分别为42.5、35.9,P值均<0.001）。在F0～F4各纤维化分期中，相同分期的FIB-4中位值均高于APRI(H=59.71,P<0.001）。FIB-4预测F3期的AUC值与APRI差异无统计学意义（0.67 vs 0.65,Z=0.71,P=0.480），预测F4期的AUC值高于APRI，差异有统计学意义（0.72 vs 0.64,Z=10.50,P<0.001）。在前瞻性研究队列中，FIB-4和APRI在出现疾病进展（慢性乙型肝炎-肝硬化）的患者中表现出随时间增加的趋势。FIB-4和APRI预测疾病进展（慢性乙型肝炎-肝硬化）的AUC分别为0.718(95%CI:0.476～0.760）和0.555(95%CI:0.408～0.703);FIB-4预测疾病进展的准确率高于APRI（χ~2=12.44,P<0.001）。结论 FIB-4和APRI均可作为评估晚期肝纤维化（F3和F4）以及预测疾病进展与否的依据，但FIB-4优于APRI。更多还原

【Abstract】 Objective To investigate the performance of fibrosis-4 (FIB-4) versus aspartate aminotransferase-to-platelet ratio index (APRI) in predicting advanced liver fibrosis and disease progression in patients with chronic HBV infection.Methods A total of 497 patients with chronic HBV infection who underwent liver biopsy in The First Affiliated Hospital of Guangxi Medical University from February 2013 to December 2022 were enrolled,among whom 404 were enrolled in a retrospective study and 75were enrolled in a prospective study.Related indicators were collected,including demographic features (sex and age),biochemical indices (alanine aminotransferase[ALT]and aspartate aminotransferase[AST]),and platelet count,and FIB-4 and APRI were calculated.The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups;the chi-square test was used for comparison of categorical data between groups.The area under the ROC curve (AUC) was used to assess the ability of APRI and FIB-4 in evaluating liver fibrosis degree and disease progression in patients with chronic HBV infection.Results In the retrospective analysis,compared with the FIB-4<2.67 group,the FIB-4≥2.67 group had a significantly higher proportion of the patients who were diagnosed with liver cirrhosis or hepatocellular carcinoma (66.19%vs 47.54%，χ2=12.75,P<0.001).The medians of FIB-4 and APRI increased significantly with liver fibrosis degree from F0 to F4 (H=42.5 and 35.9,both P<0.001).As for the fibrosis stage of F0-F4,the median of FIB-4 was significantly higher than that of APRI in the patients with the same fibrosis stage (H=59.71,P<0.001).FIB-4 and APRI had a similar AUC for predicting stage F3 fibrosis (0.67 vs 0.65,Z=0.71,P=0.480),while FIB-4 had a higher AUC for predicting stage F4 fibrosis than APRI (0.72 vs 0.64,Z=10.50,P<0.001).In the prospective study cohort,FIB-4 and APRI showed an increasing trend over time in predicting disease progression (chronic hepatitis B to liver cirrhosis),with an AUC of 0.718 (95%confidence interval[CI]:0.476—0.760) and 0.555 (95%CI:0.408—0.703),respectively,and FIB-4 had a significantly higher accuracy than APRI in predicting disease progression（χ~2=12.44,P<0.001).Conclusion FIB-4and APRI can be used to evaluate advanced liver fibrosis (F3 and F4) and predict disease progression,and FIB-4 is superior to APRI in certain aspects.更多还原