瞬时弹性成像联合FIB-4和APRI评估慢性乙型肝炎患者肝纤维化价值研究*

doi:10.3969/j.issn.1672-5069.2026.02.006

摘要/Abstract

摘要： 目的分析瞬时弹性成像(TE)联合纤维化4指数(FIB-4)和天冬氨酸氨基转移酶与血小板比率指数(APRI)评估慢性乙型肝炎(CHB)患者显著性肝纤维化的诊断价值。方法 2022年1月～2024年10月我院收治的102例CHB患者,均接受TE检查,获得肝脏硬度测量(LSM)和常规实验室检查,计算FIB-4和APRI。所有患者接受肝活检。应用二元Logistic回归分析影响CHB患者发生显著性肝纤维化的因素,应用受试者工作特征曲线(ROC)评估上述指标评估显著性肝纤维化程度的效能。结果在本组102例CHB患者中,肝组织学检查发现S0期11例,S1期25例和S2期或以上(显著性肝纤维化)66例;显著性肝纤维化组LSM、FIB-4和APRI分别为(11.6±2.1)kPa、(1.6±0.4)和(0.6±0.1),均显著高于无肝纤维化组[分别为(5.6±1.4)kPa、(1.3±0.5)和(0.4±0.1),P<0.05];多因素Logistic回归分析结果显示LSM(OR为2.857,95%CI:1.048～7.783)、FIB-4(OR为2.886,95%CI:1.267～6.575)和APRI(OR为2.264,95%CI:1.371～3.739)均为影响CHB患者发生显著性肝纤维化的独立危险因素(P<0.05);ROC曲线分析显示,LSM联合FIB-4和APRI诊断CHB患者显著性肝纤维化的AUC为0.930(95%CI:0.861～0.971),显著优于各指标单独诊断(P<0.05)。结论使用TE联合FIB-4和APRI可提高对CHB患者显著性肝纤维化的诊断效能,具有较高的临床应用价值。

关键词: 慢性乙型肝炎, 显著性肝纤维化, 瞬时弹性成像, 纤维化4因子指数, 天冬氨酸氨基转移酶与血小板比率指数, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic efficacy of transient elastography (TE) with combination of fibrosis-4 index (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) in assessing significant liver fibrosis (SLF) in patients with chronic hepatitis B(CHB). Methods A total of 102 consecutive patients with CHB were enrolled in our hospital between January 2022 and October 2024, and all received liver biopsies, TE for liver stiffness measurement (LSM), routine blood tests to calculate FIB-4 and APRI. Multivariate Logistic regression analysis was applied to reveal influencing factors, and receiver operating characteristic curve (ROC) was used to evaluate diagnostic performance. Results Of the 102 patients with CHB, liver histo-pathological examination found liver fibrosis stage 0 (S0) in 11 cases, S1 in 25 cases and S2 or above (SLF) in 66 cases; LSM, FIB-4 and APRI in patients with SLF were (11.6±2.1)kPa, (1.6±0.4) and (0.6±0.1), all much higher than [(5.6±1.4)kPa, (1.3±0.5) and (0.4±0.1), respectively, P<0.05] in those without LF; multivariate Logistic regression analysis showed that LSM (OR:2.857,95%CI:1.048-7.783), FIB-4(OR:2.886, 95%CI:1.267-6.575) and APRI(OR:2.264, 95%CI:1.371-3.739) were all the independent risk factors for SLF in patients with CHB(P<0.05); ROC analysis demonstrated that the AUC was 0.930(95%CI:0.861-0.971), when LSM in combination with FIB-4 and APRI in predicting SLF, much superior to any parameter did alone (P<0.05). Conclusion TE in combination with FIB-4 and APRI could improve the diagnostic efficacy for SLF in patients with CHB.

Key words: Hepatitis B, Liver fibrosis, Transient elastography, Fibrosis-4 index, Aspartate aminotransferase to platelet ratio index, Diagnosis

常静霞, 张丽, 盖琳, 张田龙, 郑爱兰, 郭煜. 瞬时弹性成像联合FIB-4和APRI评估慢性乙型肝炎患者肝纤维化价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 183-186.

Chang Jingxia, Zhang Li, Gai Lin, et al. Diagnostic efficacy of transient elastography with combination of FIB-4 and APRI in assessing significant liver fibrosis in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2026, 29(2): 183-186.

参考文献

[1] Yan R, Sun M, Yang H, et al. 2024 latest report on hepatitis B virus epidemiology in China: current status, changing trajectory, and challenges. Hepatobiliary Surg Nutr, 2025, 14(1):66-77.
[2] Hsu YC, Huang DQ, Nguyen MH. Global burden of hepatitis B virus: current status, missed opportunities and a call for action. Nat Rev Gastroenterol Hepatol, 2023, 20(8):524-537.
[3] Liang H, Zheng X, Liu Y, et al. Effects ofdifferent antiviral treatments on liver inflammation and fibrosis in patients with chronic hepatitis B. J Viral Hepat, 2025, 32(4):e70019.
[4] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2022年版).实用肝脏病杂志,2023,26(3)S18-39.
[5] Liguori A, Zoncapè M, Casazza G, et al. Staging liver fibrosis and cirrhosis using non-invasive tests in people with chronic hepatitis B to inform WHO 2024 guidelines: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol, 2025, 10(4):332-349.
[6] 袁瑞,刘焕,桂静,等.超声瞬时弹性成像技术评估慢性乙型肝炎病毒感染患者肝纤维化情况及其临床特征分析.中华全科医师杂志,2023,22(12):1281-1287.
[7] Chen Z, Huang Y, Zhang Y, et al. Impact of hepatic steatosis on liver stiffness measurement by vibration-controlled transient elastography and its diagnostic performance for identifying liver fibrosis in patients with chronic hepatitis B. Insights Imaging, 2024, 15(1):283.
[8] Tamaki N, Imajo K, Sharpton SR, et al. Two-step strategy, FIB-4 followed by magnetic resonance elastography, for detecting advanced fibrosis in NAFLD. Clin Gastroenterol Hepatol, 2023, 21(2):380-387,e3.
[9] Moosavy SH, Eftekhar E, Davoodian P, et al. AST/ALT ratio, APRI, and FIB-4 compared to FibroScan for the assessment of liver fibrosis in patients with chronic hepatitis B in Bandar Abbas, Hormozgan, Iran. BMC Gastroenterol, 2023, 23(1):145.
[10] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会感染病学分会.肝纤维化诊断及治疗共识(2019年).中华肝脏病杂志,2019,27(9):657-667.
[11] Tang J, Zhang J, Zhang G, et al. Stat3 activation-triggered transcriptional networks govern the early stage of HBV-induced hepatic inflammation. mBio, 2024, 15(4):e0306823.
[12] Chen C, Chen J, Wang Y, et al. Ganoderma lucidum polysaccharide inhibits HSC activation and liver fibrosis via targeting inflammation, apoptosis, cell cycle, and ECM-receptor interaction mediated by TGF-β/Smad signaling. Phytomedicine, 2023, 110:154626.
[13] 刘爱华,符建,陈小红.瞬时超声弹性成像联合GGT/PLT比值预测慢性乙型肝炎患者肝纤维化价值研究.实用肝脏病杂志,2023,26(5):634-637.
[14] 曾伟梅,董常峰,黄琨,等.声触诊弹性成像线性结合超声评分细分慢性乙肝患者肝纤维化程度.中华超声影像学杂志,2023,32(2):129-135.
[15] Kuwano A, Miyazaki M, Yada M, et al. FIB-4 index and serum α-fetoprotein are useful predictors of hepatocellular carcinoma occurrence in hepatitis B patients with nucleos(t)ide analogs therapy. Exp Ther Med, 2023, 26(3):441.
[16] Ding Y, Wang Z, Niu H, et al. FIB-4 is closer to FibroScan screen results to detecting advanced liver fibrosis and maybe facilitates NAFLD warning. Medicine (Baltimore), 2023, 102(34):e34957.
[17] Reddy S, Agrawal S, Reddy H, et al. Assessing theutility of the aspartate aminotransferase to platelet ratio index (APRI) as a noninvasive indicator for liver cirrhosis, Cureus, 2024, 16(5):e59680.
[18] Chen L, Tao X, Zeng M, et al. Noninvasive tests maintain high accuracy for advanced fibrosis in chronic hepatitis B patients with different nomenclatures of steatotic liver disease, J Med Virol, 2024, 96(4):e29613.
[19] 王常鹤,朱璇,邓静,等.超声剪切波弹性成像联合AAR、APRI和FIB-4诊断慢性乙型肝炎患者肝纤维化程度效能研究.实用肝脏病杂志,2025,28(1):32-35.
[20] Chang M, Chang D, Kodali S, et al. Degree ofdiscordance between FIB-4 and transient elastography: An application of current guidelines on general population cohort. Clin Gastroenterol Hepatol, 2024, 22(7):1453-1461,e2.
[21] Con D, Tu S, Clayton-Chubb D, et al. Effect ofconcurrent metabolic dysfunction-associated steatotic liver disease on serial non-invasive fibrosis markers in chronic hepatitis B. Dig Dis Sci, 2024, 69(4):1496-1506.
[22] Gür-Altunay D, Yürük-Atasoy P. How successful are APRI and FIB-4 scores in predicting liver fibrosis in chronic hepatitis B patients? Infect Dis Clin Microbiol, 2023, 5(4):332-340.
[23] Zhang Z, Wang J, Zhu L, et al. Optimization of theuse of APRI and FIB-4 for ruling out liver cirrhosis in chronic hepatitis B patients with normal alanine aminotransferase. J Viral Hepat, 2025, 32(2):e14057.

瞬时弹性成像联合FIB-4和APRI评估慢性乙型肝炎患者肝纤维化价值研究^*

Diagnostic efficacy of transient elastography with combination of FIB-4 and APRI in assessing significant liver fibrosis in patients with chronic hepatitis B

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	王玲玲, 张召, 徐玉. 影响Peg-IFNα-2b治疗HBeAg阴性慢性乙型肝炎患者早期病毒学应答的因素分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 175-178.
[2]	何红梅, 沙志虎, 邵建国, 徐姝嫣. 恩替卡韦联合软肝散结方治疗慢性乙型肝炎患者临床疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 179-182.
[3]	黄炎芳, 李远, 李政, 黎坚. 血清腱糖蛋白-C和多种肝纤维化指数诊断慢性乙型肝炎患者肝纤维化效能研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 187-190.
[4]	张卉新, 隋雪梅. 声触诊组织量化技术联合其他指标诊断慢性乙型肝炎患者肝纤维化效能临床研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 191-194.
[5]	张萌, 许怀利, 杨小飞, 杨湘敏, 张鹏飞. 非酒精性脂肪性肝病患者血清趋化因子CXCL12及其受体CXCR4和CXCR7水平变化临床意义研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 205-208.
[6]	吴娟, 段艳, 乞艳华. 超声受控衰减参数与二维超声剪切波弹性成像评估代谢功能障碍相关脂肪性肝病患者肝纤维化效能比较^*[J]. 实用肝脏病杂志, 2026, 29(2): 217-220.
[7]	储茜, 景龙宵, 张力, 孙恒亮. 血清PCT、IL-26和IFN-γ水平联合MELD评分预测慢加急性乙型肝炎肝衰竭患者感染价值探讨^*[J]. 实用肝脏病杂志, 2026, 29(2): 233-236.
[8]	孙博汉, 曹春莉, 奇丽娜. MELD评分联合血清胱抑素C和ALBI评分诊断失代偿期肝硬化患者并发肝肾综合征价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 249-252.
[9]	李军勇, 陈华, 黄毅利. 实时组织弹性成像联合APRI和FIB-4预测乙型肝炎肝硬化患者并发食管静脉曲张价值分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 261-264.
[10]	刘立楠, 常宇飞, 王卉. 肝硬化并发脓毒症患者SOFA评分和MELD-Na⁺评分变化及其临床意义探讨[J]. 实用肝脏病杂志, 2026, 29(2): 273-276.
[11]	吉盛超, 耿承军, 陆泽华, 叶黛西, 冯浩, 金晓凤, 陈利华. 基于增强CT和MRI参数构建模型鉴别诊断不典型肝细胞癌与肿块型肝内胆管细胞癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 281-284.
[12]	石国富, 朱志韬, 张苏波, 金怀玉. MSCT联合增强MRI鉴别诊断肝脏局灶性结节性增生与肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 301-304.
[13]	王威, 孟云, 冀鹏. 磁共振增强扫描量化参数鉴别诊断肝脏良恶性占位性病变价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 305-308.
[14]	吴江云, 习广晓, 韩菲燕. 动态三维超声造影联合剪切波弹性成像鉴别诊断良恶性肝脏局灶性病变价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 309-312.
[15]	焦婧然, 徐曼曼, 陈煜. 价值医疗导向的DRG支付对重症肝病诊疗的影响^*[J]. 实用肝脏病杂志, 2026, 29(1): 1-4.