目的：探讨 FIB-4指数对谷丙转氨酶（ ALT）小于2倍正常值上限的慢性乙型肝炎病毒（HBV）感染患者肝纤维化程度的诊断价值。方法对416例 ALT 小于2倍正常值上限的慢性 HBV 感染患者进行肝脏穿刺病理检查，同时检测肝穿当天患者的 ALT、谷草转氨酶（AST）、血小板等指标。根据 FIB-4计算公式得出 FIB-4指数值，以肝穿病理结果为金标准绘制 FIB-4指数的受试者工作特征曲线（ROC），计算曲线下面积，评价 FIB-4指数对显著肝纤维化、严重肝纤维化和肝硬化的预测价值。结果随着肝纤维化程度的加重， FIB-4指数逐步升高，在 S1~ S44组间差异有统计学意义（P<0.05）。E 抗原阳性与阴性患者的 FIB-4指数比较差异有统计学意义（ P <0.05）。E 抗原阳性患者诊断显著肝纤维化、严重肝纤维化、肝硬化的 FIB-4指数截断值分别为1.283、1.283和1.449，分别对应不同的灵敏度和特异度。而在 E 抗原阴性的患者中，其相应的截断值为2.094、2.094和2.415。结论 FIB-4指数对于 ALT 小于2倍正常值上限的慢性 HBV 感染患者是一种简单、有效的无创肝纤维化评价指标，可使大部分患者避免肝穿活检。%Objective To explore the diagnostic value of FIB-4 index to liver fibrosis in chronic hepatitis B virus infection patients with alanine aminotransferase(ALT)less than two times of upper limits of normal. Methods A total of 416 clinically diagnosed chronic HBV infection with ALT less than two times of upper limits of normal were enrolled to liver biopsy and routine laboratory tests. The serum levels ALT,AST and PLT were also performed to calculate the FIB-4 index with the formula. Diagnostic performance of FIB-4 was assessed by using receive operat-ing characteristic curves and area under the receive operating characteristic curve analysis with liver biopsy as the gold standard. Results As the degree of liver fibrosis was aggravating,FIB-4 index increased gradually. There were significant differences between the groups of S1 to S4,the same to the groups of E antigen positive and nega-tive(P < 0. 05). In the HBeAg positive group,the cutoff value was 1. 283 for significant liver fibrosis,1. 283 for severe liver fibrosis and 1. 445 for cirrhosis,corresponding to different degree of sensitivity and specificity. In HBeAg negative patients,the corresponding cutoff value was 2. 094,2. 094 and 2. 415. Conclusion The FIB-4 index is a simple and effective noninvasive hepatic fibrosis index and it keeps most of the patients from liver biopsy.
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