我国研究人员做的一项大型荟萃分析表明，天冬
氨酸氨基转移酶/血小板指数（APRI）对丙型肝炎相关的肝纤维化的鉴定具有中度准确性。应用该指标可降低慢性丙型肝炎（CHC）患者进行肝活检检查的必要性。该论文发表在3月份的《Hepatology》上[Hepatology. 2011 Mar;53(3):726-36]。
APRI检测费用低，且应用范围较广，是一种前景广阔、可以取代肝脏活检的非侵入性肝纤维化检测方法。该研究的目的是对2007年的荟萃分析结果进行更新，以系统性地评估HCV单独感染患者和HCV/HIV复合感染患者中APRI对显著纤维化、重度纤维化及肝硬化等分期诊断的准确性。在研究中，研究者比较了丙型肝炎患者的APRI检查和活检检查，通过广泛彻底的文献检索对其结果进行了鉴定，并采用了接受者操作曲线下面积(AUROC)、敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)对APRI诊断显著纤维化、重度纤维化及肝硬化的准确性进行检测。患者的人口特征经meta回归分析法进行了探究。
本次更新纳入了21个新研究，总共回顾分析了40个研究（病例数8739例）。APRI在诊断显著纤维化、严重纤维化及肝硬化时的AUROC值分别为 0.77，0.80和0.83。对于显著纤维化患者，以0.7为临界值，APRI诊断的敏感性为77%，特异性为72%。对于重度纤维化患者，以1.0为 临界值，APRI诊断的敏感性为61%，特异性为64%。对于肝硬化患者，以1.0为临界值，APRI诊断的敏感性为76%，特异性为72%。不仅如此，研究者还发现，APRI在鉴定HIV/HCV复合感染患者的显著纤维化、重度纤维化和肝硬化方面准确性较低。
医脉通推荐英文摘要
Hepatology 2010.12.7 DOI: 10.1002/hep.24105
Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: An updated meta-analysis
Zhong-Hua Lin, Yong-Ning Xin, Quan-Jiang Dong，et al.
（Medical College of Qingdao University, Qingdao, Shandong Province, China）
Aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to update the 2007 meta-analysis to systematically assess the accuracy of APRI in predicting significant fibrosis, severe fibrosis and cirrhosis stage in HCV mono-infected and HCV/HIV co-infected individuals. Studies comparing APRI versus biopsy in HCV patients were identified via a thorough literature search. Areas under summary receiver operating characteristic curves (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to examine the APRI accuracy for the diagnosis of significant fibrosis, severe fibrosis and cirrhosis. Heterogeneity was explored using meta-regression. Twenty one additional studies were eligible for the update and, in total, 40 studies were included in this review (n=8,739). The summary AUROC of the APRI for the diagnosis of significant fibrosis, severe fibrosis and cirrhosis were 0.77, 0.80 and 0.83, respectively. For significant fibrosis, an APRI threshold of 0.7 was 77% sensitive and 72% specific. For severe fibrosis, a threshold of 1.0 was 61% sensitive and 64% specific. For cirrhosis, a threshold of 1.0 was 76% sensitive and 72% specific. Moreover, we found that the APRI was less accurate for the identification of significant fibrosis, severe fibrosis and cirrhosis in HIV/HCV co-infected patients.
Conclusion:
Our large meta-analysis suggests that APRI can identify hepatitis C-related fibrosis with a moderate degree of accuracy. Application of this index may decrease the need for staging liver biopsy specimens among CHC patients.
