Comparison of Diagnostic Accuracy of Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis-4 Index for Detecting Liver Fibrosis in Adult Patients With Chronic Hepatitis B Virus Infection: A Systemic Review and Meta-analysis
Comparison of Diagnostic Accuracy of Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis-4 Index for Detecting Liver Fibrosis in Adult Patients With Chronic Hepatitis B Virus Infection: A Systemic Review and Meta-analysis
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DOI：
10.1002/hep.27382
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发表时间：
2015-01-01
期刊：
影响因子：
13.5
通讯作者：
Yan, Lunan
中科院分区：
文献类型：
--
作者：
Xiao, Guangqin;Yang, Jiayin;Yan, Lunan
天冬氨酸转氨酶与血小板比率指数（APRI）和基于四个因素的纤维化指数（纤维化4指数; FIB-4）是评估肝纤维化的两个最广泛研究的非侵入性工具。本研究旨在系统评价APRI和FI B-4在成人B病毒（HBV）感染中的表现，并比较其优缺点。我们基于APRI和FIB-4的敏感性、特异性、阳性预测值、阴性预测值和受试者工作特征曲线下面积（AUROC），检测了APRI和FIB-4对严重纤维化、晚期纤维化和肝硬化的诊断准确性。使用元回归探索异质性。我们的系统回顾和荟萃分析包括16篇仅APRI的文章，21篇APRI和FIB-4的文章，以及2篇FIB-4检测不同程度肝纤维化的文章。当APRI阈值为0.5、1.0和1.5时，显著纤维化、晚期纤维化和肝硬化的敏感性和特异性分别为70.0%和60.0%、50.0%和83.0%、36.9%和92.5%。当FIB-4阈值为1.45和3.25时，显著纤维化的敏感性和特异性分别为65.4%和73.6%以及16.2%和95.2%。使用APRI和FIB-4诊断严重纤维化、晚期纤维化和肝硬化的汇总AUROC值为0.7407（95%置信区间[CI]：0.7033-0.7781）和0.7844（95%CI：0.7450-0.8238; Z=1.59，P=0.06），0.7347（95% CI：0.6790-0.7904）和0.8165（95%CI：0.7707-0.8623; Z=2.01，P=0.02）、0.7268（95%CI：0.6578-0.7958）和0.8448（95%CI：0.7742-0.9154; Z=2.34，P=0.01）。结论：我们的荟萃分析表明，APRI和FIB-4可以识别乙型肝炎相关纤维化，具有中等的敏感性和准确性。（肝病学2015;61：292-302）
The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fibrosis 4 index; FIB-4) are the two most widely studied noninvasive tools for assessing liver fibrosis. Our aims were to systematically review the performance of APRI and FIB-4 in hepatitis B virus (HBV) infection in adult patients and compare their advantages and disadvantages. We examined the diagnostic accuracy of APRI and FIB-4 for significant fibrosis, advanced fibrosis, and cirrhosis based on their sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUROC). Heterogeneity was explored using metaregression. Our systemic review and meta-analysis included 16 articles of APRI only, 21 articles of APRI and FIB-4 and two articles of FIB-4 for detecting different levels of liver fibrosis. With an APRI threshold of 0.5, 1.0, and 1.5, the sensitivity and specificity values were 70.0% and 60.0%, 50.0% and 83.0%, and 36.9% and 92.5% for significant fibrosis, advanced fibrosis, and cirrhosis, respectively. With an FIB-4 threshold of 1.45 and 3.25, the sensitivity and specificity values were 65.4% and 73.6% and 16.2% and 95.2% for significant fibrosis. The summary AUROC values using APRI and FIB-4 for the diagnosis of significant fibrosis, advanced fibrosis, and cirrhosis were 0.7407 (95% confidence interval [CI]: 0.7033-0.7781) and 0.7844 (95% CI: 0.7450-0.8238; (Z=1.59, P=0.06), 0.7347 (95% CI: 0.6790-0.7904) and 0.8165 (95% CI: 0.7707-0.8623; Z=2.01, P=0.02), and 0.7268 (95% CI: 0.6578-0.7958) and 0.8448 (95% CI: 0.7742-0.9154; (Z=2.34, P=0.01), respectively. Conclusions: Our meta-analysis suggests that APRI and FIB-4 can identify hepatitis B-related fibrosis with a moderate sensitivity and accuracy. (Hepatology 2015;61:292-302)