Clinical utility of aspartate aminotransferase to platelet ratio index in chronic hepatitis B virus infection with transaminase less than two times of upper limits of normal / 中华传染病杂志

ABSTRACT

Objective To evaluate the performance of aspartate aminotransferase to platelet ratio index (APRI) in the assessment of fibrosis in chronic hepatitis B virus (HBV) infection patients with transaminase level less than two times of upper limits of normal (ULN),and to analyze the clinical utility in antiviral therapy.Methods A total of 349 clinically diagnosed chronic HBV infection with alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level less than 2 × ULN were enrolled.Liver biopsy and routine laboratory tests were performed to calculate the ratio of AST to platelet (PLT),namely the APRI,and to compare the relationship between liver fibrosis and APRI.Diagnostic performance of APRI model was assessed by using receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) analysis.Correlation between APRI and liver fibrosis was determined by Spearman rank correlation analysis.Results The AUC of APRI≥0.273 for significant liver fibrosis was 0.641 with sensitivity of 48.3％,specificity of 75.7％ and positive predictive value of 73.9％.The AUC of APRI≥0.311 for cirrhosis was 0.771 with sensitivity of 68.6％,specificity of 76.8％,and negative predictive value of 93.5％.In patients with HBV DNA level ranging from 1 × 103 to 1 × 105 copy/mL,the optimal cut-off value of APRI was 0.179 for significant fibrosis (P＝0.00) and 0.283 for cirrhosis (P=0.00).By Spearman rank correlation analysis,APRI was positively correlated with histologic stages of fibrosis (r=0.370,P＜0.01).Conclusions APRI can be utilized to assess liver fibrosis in HBV infection with ALT and AST level less than 2 × ULN.APRI≥0.273 (pathologic stages of fibrosis ≥S2) has obvious hepatic fibrosis,which may help physician to select the optimal time for antiviral therapy.APRI may serve as a potential tool for assessing liver fibrosis according to HBV DNA levels.