Objective: To compare the clinical value of FibroScan, FIB-4, APRI and AAR diagnosing hepatic fibrosis in chronic hepatitis B virus (HBV) carriers. Methods: A total of 213 patients with chronic HBV carriers diagnosed by clinical and liver biopsy were selected. And according to HBeAg status, 149 patients were divided into HBeAg-positive group and 64 patients were divided into HBeAg-negative group. The liver stiffness measurements (LSM) was measured by FibroScan (FS), FIB-4, APRI and AAR values were calculated using FIB-4, APRI and AAR formula. And all patients underwent liver biopsy in the same period. According to the degree of hepatic fibrosis in Knodell, one decision point was set: significant hepatic fibrosis (S ≥ 2). The Spearman correlation analysis method was used to analyze the correlation of indicators and the area under receiver operator characteristic curves (AUROCs) of LSM, FIB-4, APRI and AAR were drawn according to liver biopsy pathology results as gold standard. The value of LSM, FIB-4, APRI and AAR diagnosing hepatic fibrosis in chronic HBV carriers was retrospectively analyzed. Retrospective analysis of FS, FIB-4, APRI and AAR were divided into 149 HBeAg-positive chronic HBV carriers (HBeAg-positive group) and 64 HBeAg-negative chronic HBV carriers (HBeAg) in 213 patients with chronic HBV carriers and HBeAg Negative group) in the diagnosis of liver fibrosis. Results: The LSM of 213 patients with chronic HBV carriers, 149 patients with HBeAg-positive chronic HBV carriers and 64 patients with HBeAg-negative chronic HBV carriers were significantly correlated with liver fibrosis grade≥ 2 (P < 0.001). Regardless of HBeAg status, only LSM in the three groups had moderate evaluation efficacy for evaluating significant fibrosis(S≥2), and the positive predictive value was more than 94%, but the diagnostic accuracy was not high, the minimum was 46.31% (HBeAg-positive group), the maximum value of 67.19% (HBeAg-negative group), while the remaining three kinds of serum noninvasive liver fibrosis diagnostic model indicators and diagnostic efficacy are low. The LSM in the three groups showed a significant positive correlation with liver fibrosis grade (S)≥2. Conclusion: LSM is more accurate than FIB-4, APRI and AAR in diagnosing chronic HBV carriers. Dynamically monitoring changes of LSM can earlier understand the progress of liver fibrosis than the three kinds of serology noninvasive diagnostic model and is contributed to the choice of liver biopsy timing.
目的： 比较肝脏瞬时弹性探测仪（FS）、FIB-4（Fibrosis-4）、天冬氨酸氨基转移酶/血小板比值指数（APRI）和天冬氨酸/丙氨酸氨基转移酶比率（AAR）诊断慢性乙型肝炎病毒(HBV)携带者肝纤维化的临床价值。 方法： 选取临床诊断并经肝脏活体组织检查（肝活检）确诊的213例慢性HBV携带者（A组），并按HBeAg状态再分为149例HBeAg阳性慢性HBV携带者（B组）及64例HBeAg阴性慢性HBV携带者（C组），使用FS测得肝硬度测定值（LSM），使用FIB-4、APRI及AAR公式计算出FIB-4、APRI及AAR数值,同期所有患者均进行肝活检,按Knodell肝组织纤维化程度设定显著纤维化（S≥2）为判定点，采用Spearman相关分析法分析指标相关性并以肝活检病理学结果为金标准绘制出LSM、FIB-4、APRI和AAR的受试者工作特征曲线并计算其曲线下面积（AUROC），采用Spearman相关系数进行相关性分析，回顾性分析FS、FIB-4、APRI及AAR对慢性HBV携带者肝纤维化程度的诊断价值。 结果： 无论是否按HBeAg状态分层，3组中只有LSM具有中等度评价S≥2的效能，且阳性预测值均达到94%以上，但诊断准确率不高，最小值为46.31%（B组），最大值为67.19%（C组）；其余3种血清无创肝纤维化诊断模型的指标及诊断效能均低。3组的LSM均与S≥2呈正相关（P < 0.001）。 结论： FS较FIB-4、APRI和AAR诊断慢性HBV携带者肝纤维化程度的准确性高，采用FS动态监测LSM的变化较上述3种血清学无创诊断模型能更早期地了解肝纤维化的进展，有助于肝活检时机的选择。.
Keywords: Chronic hepatitis B virus carrier; Liver biopsy; Noninvasive diagnosis.