目的：研究Fibroscan与APRI诊断年龄＞40岁且ALT持续正常的慢性乙型肝炎患者肝纤维化程度的价值。方法对138例符合条件的患者行肝脏活检确定病理分级。测定LSM值及APRI值，分析这两种方法诊断2级以上肝纤维化的ROC曲线下面积（F ≥2，F0～F1与F2～F4对比），从而判断这两种方法的诊断价值，并将两种方法进行并联实验、串联实验，以研究联合两种方法的诊断价值。结果Fibroscan诊断2级以上肝纤维化的AUROC为0.880，其cutoff值为6.95 kPa，敏感度为88.9%，特异性为76.3%。APRI诊断2级以上肝纤维化的AUROC为0.865，其cutoff值为0.58，敏感度为73.3%，特异性为81.7%。两种方法并联诊断2级以上肝纤维化敏感度为97.78%，特异性为68.82%，阳性预测值为60.27%，阴性预测值为98.46%；串联诊断2级以上肝纤维化敏感度为60.00%，特异性为91.40%，阳性预测值为77.14%，阴性预测值为82.52%。结论应用Fibroscan和APRI这两种无创诊断肝纤维化的方法可以较好的诊断年龄＞40岁且ALT持续正常的慢性乙型肝炎患者肝纤维化程度。%Objective To discuss the diagnostic value of Fibroscan and APRI in liver fibrosis of chronic hepatitis B patients with age>40 years old and continuous normal ALT. Methods Total of 138 cases were undergone liver biopsy to determine the pathological grade. The value of LSM and APRI were detected and compared, the area under the receiver operating curve (AUROC) were analyzed for the diagnosis of significant liver fibrosis (F≥2, F0~F1 vs F2~F4). Then the two methods were done by parallel experiments and series of experiments to discuss the diagnostic value of combined method. Results AUROC of LSM for significant liver fibrosis was 0.880, the sensitivity was 88.9% and the specificity was 76.3%. The AUROC of APRI for significant liver fibrosis was 0.865, the sensitivity was 73.3% and the specificity was 68.82%. The sensitivity of two methods in parallel diagnosis of significant liver fibrosis was 97.78%, the specificity was 68.82%, the positive predictive value was 60.27%, and the negative predictive value was 98.46%. The sensitivity for two methods in tandem diagnosing significant liver fibrosis was 60.00%, the specificity was 91.40%, the positive predictive value was 77.14%, and the negative predictive value was 82.52%. Conclusions The application of fibroscan and APRI can better diagnose liver fibrosis of patients with chronic hepatitis B, who were older than 40 and with continuous normal ALT.
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