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摘要：
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摘要：目的 探讨亮氨酸氨基肽酶（leucine aminopeptidase，LAP）联合纤维化-4
（fibrosis-4，FIB-4）指数和天冬氨酸氨基转移酶与血小板比值（aspartate aminotransferase
to platelet ratio，APRI）评分在慢性乙型肝炎（chronic hepatitis B，CHB）肝纤维化及早
期肝硬化诊断中的价值。方法 以2018年1月1日至2023年12月1日就诊于中国中医科学院
西苑医院肝病科的857例行肝脏瞬时弹性成像（transient elastography，TE）检查的CHB患
者为研究对象，根据肝脏硬度值（liver stiffness measurement，LSM）将患者分为F0期组
（LSM ＜ 7.3 kPa，330例）、F1～F2期组（7.4 kPa ≤ LSM ＜ 12.3 kPa，302例）、F3期
组（12.4 kPa ≤ LSM ＜ 17.4 kPa，75例）及F4期组（LSM ≥ 17.5 kPa，140例）。记录
各组患者的生物化学指标，计算FIB-4指数及APRI评分。应用多元Logistic回归分析构
建LAP、FIB-4指数、APRI评分联合预测模型，采用受试者工作特征（receiver operator
characteristic，ROC）曲线评估LAP、FIB-4指数、APRI评分及联合模型对CHB肝纤维
化和早期肝硬化的预测价值。结果 F0期组、F1～F2期组、F3期组及F4期组患者LAP
（中位数：48.00 U/L比52.00 U/L比55.00 U/L比57.00 U/L）、FIB-4指数（中位数：0.95
比1.16比1.32比2.42）、APRI评分（中位数：0.23分比0.28分比0.34分比0.54分）差异均
有统计学意义（P均＜ 0.05）。构建的LAP、FIB-4指数、APRI评分预测肝纤维化及早期
肝硬化的联合预测模型为Y = 1 /（0.13486 － 0.002 × LAP － 0.011 × APRI － 0.009 × FIB-4），
其预测重度肝纤维化（F3期）、早期肝硬化（F4期）的ROC曲线下面积分别为0.635、
0.849。结论 LAP、APRI评分及FIB-4指数对CHB不同程度肝纤维化及早期肝硬化有一
定诊断价值，三者联合预测模型对重度肝纤维化（F3期）及早期肝硬化（F4期）预测
价值较高。
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Abstract: Objective To investigate the predictive value of leucine aminopeptidase (LAP)
combined with spartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) on
liver fibrosis and early cirrhosis in chronic hepatitis B (CHB). Methods A total of 857 patients
diagnosed with CHB who underwent transient elastography (TE) examination and received
treatment at the Department of Liver Diseases, Xiyuan Hospital, China Academy of Chinese
Medical Sciences from January 1st, 2018 to December 1st, 2023 were included in this study.
The patients were divided into F0 group (LSM ＜ 7.3 kPa, 330 cases), F1～F2 group (7.4 kPa ≤
LSM ＜ 12.3 kPa, 302 cases), F3 group (12.4 kPa ≤ LSM ＜ 17.4 kPa, 75 cases) and F4 group
(LSM ≥ 17.5 kPa, 140 cases) according to liver stiffness measurements (LSM) obtained from
TE. The biochemical indexes of patients in each group were recorded and FIB-4 and APRI
score were calculated. A combined prediction model of LAP, FIB-4 index and APRI score was
constructed by multiple Logistic regression analysis, and receiver operating characteristic (ROC)
curve was used to evaluate the predictive value of LAP, FIB-4, APRI score and combined
model on liver fibrosis and early cirrhosis in CHB. Results There were statistically significant
differences in LAP (median: 48.00 U/L vs. 52.00 U/L vs. 55.00 U/L vs. 57.00 U/L), FIB-4
(median: 0.95 vs. 1.16 vs. 1.32 vs. 2.42) and APRI score (median: 0.23 points vs. 0.28 points
vs. 0.34 points vs. 0.54 points ) among patients in F0, F1～F2, F3 and F4 groups (all P ＜ 0.05).
The combined prediction model of LAP, FIB-4 and APRI score constructed for predicting
liver fibrosis and early cirrhosis was Y = 1 /（0.13486 － 0.002 × LAP － 0.011 × APRI －
0.009 × FIB-4), and the area under the ROC curve for predicting severe liver fibrosis (F3
stage) and early liver cirrhosis (F4 stage) was 0.635 and 0.849, respectively. Conclusions
LAP, APRI score and FIB-4 have certain diagnostic value for different degrees of liver fibrosis
and early cirrhosis in CHB. The combined prediction model has high predictive value for
severe liver fibrosis (F3 stage) and early cirrhosis (F4 stage).
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