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AC...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 P = 0.011);FIB-4指数 ≥ 11.4的患者90天生存率为43.24%,低于FIB-4 P = 0.017);差异有统计学意义(P P = 0.010);FIB-4指数 ≥ 11.4的患者90天生存率为45.16%,低于FIB-4 P = 0.021),差异有统计学意义(P 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 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 P = 0.017). The difference was statistically significant (P 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 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.展开更多
目的探讨血清甘胆酸(glycocholic acid,CG)、总胆汁酸(total bile acid,TBA)等生化指标联合天冬氨酸转氨酶(AST)/血小板(PLT)比率指数(APRI)对肝脏疾病的诊断价值。方法选取90例肝病患者,按临床诊断分成病毒性肝炎(36例)、肝硬化(36例)...目的探讨血清甘胆酸(glycocholic acid,CG)、总胆汁酸(total bile acid,TBA)等生化指标联合天冬氨酸转氨酶(AST)/血小板(PLT)比率指数(APRI)对肝脏疾病的诊断价值。方法选取90例肝病患者,按临床诊断分成病毒性肝炎(36例)、肝硬化(36例)和肝癌(18例)3个亚组,另选取同期进行健康体检人员45例作为健康对照组。测定CG、TBA等各项生化指标并通过公式计算相应指数,经统计学分析单个生化指标以及将各生化指标进行不同组合后,分别分析其与肝脏疾病的相关性,探究其在诊断肝脏疾病中的应用价值。结果除病毒性肝炎组的FIB-4外,肝病组中其余指标均显著高于健康对照组(P<0.05)。除血清ALT指标外,肝硬化和肝癌组各指标均高于病毒性肝炎组(P<0.05);受试者工作曲线分析显示,TBA曲线下面积最大,且灵敏性最高;CG的特异性最高;APRI相关指标数据优于丙氨酸氨基转移酶(ALT)等传统肝功能指标;联合CG、TBA、APRI 3个指标进行肝脏疾病诊断时,其阳性检出率最高。结论在肝脏疾病的诊断中,血清TBA和CG的诊断效能较高,并且与APRI 3者联合应用在提示肝脏不同疾病时具有一定的临床价值。展开更多
Background and Objectives: The indication for treatment in HBsAg-positive patients with low viral load and normal transaminases requires an assessment of fibrosis. In resource-limited settings, free hepatic fibrosis e...Background and Objectives: The indication for treatment in HBsAg-positive patients with low viral load and normal transaminases requires an assessment of fibrosis. In resource-limited settings, free hepatic fibrosis evaluation tests can aid in therapeutic decision-making. Our study aims to demonstrate the utility of assessing hepatic fibrosis using non-invasive markers (APRI and FIB-4) in patients with chronic B viral hepatitis without cytolytic activity and low viral replication in our context. Patients and Methods: This is a retrospective cross-sectional study conducted between January 2018 and December 2021 at the University Hospital Center of Bouaké. Included were all patients aged ≥18 with normal transaminases (Results: Our study included 241 patients, with a mean age of 36.19 years (±10.52 years) and a male predominance of 52%. The mean FibroScan<sup>®</sup> value was 6.44 ± 2.3 kPa, and 68 patients (28.22%) had fibrosis >7 kPa. To exclude significant fibrosis (FS Conclusion: A significant proportion of HBV-infected patients with normal ALT and low viral load have active liver disease. Both FIB-4 and APRI biological scores are useful in identifying individuals without significant fibrosis with a good negative predictive value (>50%).展开更多
目的探讨瞬时弹性成像技术(Fibro Scan)、天冬氨酸氨基转移酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)及其二者联合检测肝硬化患者合并食管胃底静脉曲张破裂出血风险的相关性和诊断预测价值.方法将...目的探讨瞬时弹性成像技术(Fibro Scan)、天冬氨酸氨基转移酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)及其二者联合检测肝硬化患者合并食管胃底静脉曲张破裂出血风险的相关性和诊断预测价值.方法将210例病毒性肝炎肝炎后肝硬化患者根据2015年《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》分为无、有出血组,分别为153、57例;搜集患者在1 wk内的Fibro Scan值[肝脏硬度值(liver stiffness measurement,L S M)]和A P R I值.组间比较采用t检验,利用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析LSM、APRI、LSM+APRI对肝硬化患者出血风险的预测价值,并比较LSM、APRI及LSM+APRI的ROC曲线下面积(area under curve,AUC).结果有、无出血组的LSM值分别是28.49 k Pa±9.46 k Pa,22.87 k Pa±6.95 k Pa,APRI值分别是2.99±1.11,2.13±1.01,有明显的统计学意义.有无出血风险的LSM、APRI、LSM+APRI的AUC分别是0.669、0.727、0.722,表明APRI、LSM+APRI对食管胃底静脉曲张破裂出血具有良好的诊断效果.结论APRI及Fibro Scan联合APRI对肝硬化患者合并食管胃底静脉曲张破裂出血风险存在有效的预测价值.展开更多
目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检...目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检测,并分析APRI、血氨值与HE之间的关系。结果伴有HE患者的Child分级和MELD评分均高于无HE者,差异有统计学意义(P<0.05)。APRI值在HE组的值为4.38±2.68,高于无HE组的2.19±1.75,差异有统计学意义(t=-4.721,P<0.001)。APRI值在不同HE分级中的分布:1级3.70±0.55、2级5.30±0.43、3~4级5.75±1.27,1级<2级<3~4级,差异有统计学意义(H=6.704,P=0.035)。血氨值在不同HE分级中的分布:1级(108.0±6.1)μg/dl、2级(130.4±23.4)μg/dl、3~4级(170.5±12.5)μg/dl,1级<2级<3~4级,差异有统计学意义(H=10.95,P=0.004)。APRI与血氨联合诊断HE时,ROC曲线下面积为0.898,敏感度为91.8%,特异度为96.9%。结论 APRI和血氨联合检测诊断HE效能较高,具有较好的临床应用价值。展开更多
文摘目的: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 P = 0.011);FIB-4指数 ≥ 11.4的患者90天生存率为43.24%,低于FIB-4 P = 0.017);差异有统计学意义(P P = 0.010);FIB-4指数 ≥ 11.4的患者90天生存率为45.16%,低于FIB-4 P = 0.021),差异有统计学意义(P 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 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 P = 0.017). The difference was statistically significant (P 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 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.
文摘Background and Objectives: The indication for treatment in HBsAg-positive patients with low viral load and normal transaminases requires an assessment of fibrosis. In resource-limited settings, free hepatic fibrosis evaluation tests can aid in therapeutic decision-making. Our study aims to demonstrate the utility of assessing hepatic fibrosis using non-invasive markers (APRI and FIB-4) in patients with chronic B viral hepatitis without cytolytic activity and low viral replication in our context. Patients and Methods: This is a retrospective cross-sectional study conducted between January 2018 and December 2021 at the University Hospital Center of Bouaké. Included were all patients aged ≥18 with normal transaminases (Results: Our study included 241 patients, with a mean age of 36.19 years (±10.52 years) and a male predominance of 52%. The mean FibroScan<sup>®</sup> value was 6.44 ± 2.3 kPa, and 68 patients (28.22%) had fibrosis >7 kPa. To exclude significant fibrosis (FS Conclusion: A significant proportion of HBV-infected patients with normal ALT and low viral load have active liver disease. Both FIB-4 and APRI biological scores are useful in identifying individuals without significant fibrosis with a good negative predictive value (>50%).
文摘目的探讨瞬时弹性成像技术(Fibro Scan)、天冬氨酸氨基转移酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)及其二者联合检测肝硬化患者合并食管胃底静脉曲张破裂出血风险的相关性和诊断预测价值.方法将210例病毒性肝炎肝炎后肝硬化患者根据2015年《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》分为无、有出血组,分别为153、57例;搜集患者在1 wk内的Fibro Scan值[肝脏硬度值(liver stiffness measurement,L S M)]和A P R I值.组间比较采用t检验,利用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析LSM、APRI、LSM+APRI对肝硬化患者出血风险的预测价值,并比较LSM、APRI及LSM+APRI的ROC曲线下面积(area under curve,AUC).结果有、无出血组的LSM值分别是28.49 k Pa±9.46 k Pa,22.87 k Pa±6.95 k Pa,APRI值分别是2.99±1.11,2.13±1.01,有明显的统计学意义.有无出血风险的LSM、APRI、LSM+APRI的AUC分别是0.669、0.727、0.722,表明APRI、LSM+APRI对食管胃底静脉曲张破裂出血具有良好的诊断效果.结论APRI及Fibro Scan联合APRI对肝硬化患者合并食管胃底静脉曲张破裂出血风险存在有效的预测价值.
