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目的:评估肝脏瞬时弹性成像、天冬氨酸转氨酶与血小板比值指数（APRI）及基于4因子的肝纤维化指数（FIB-4）对儿童非酒精性脂肪性肝病（NAFLD）肝纤维化的诊断价值。方法:选取湖南省儿童医院2015年8月至2020年10月已行肝穿刺病理活检的非酒精性脂肪性肝病100例进行回顾性研究，收集肝脏病理组织和临床资料。采用受试者操作特征曲线（ROC曲线）分析肝脏硬度（LSM）值、APRI及FIB-4诊断儿童NAFLD所致不同肝脏纤维化的诊断价值。结果:LSM值、APRI、FIB-4诊断肝纤维化（S≥1）的ROC曲线下面积(AUC)分别为0.701[95%可信区间（n CI）：0.579~0.822，n P = 0.011]、0.606（95%n CI：0.436~0.775，n P = 0.182）、0.568（95%n CI：0.397~0.740，n P = 0.387），最佳临界值分别为6.65 kPa、21.20、0.18；LSM值、APRI、FIB-4诊断显著肝纤维化（S≥2）的AUC分别为0.660（95%n CI：0.552~0.768，n P = 0.006）、0.578（95%n CI：0.464~0.691，n P = 0.182）、0.541（95%n CI：0.427~0.655，n P = 0.482），最佳临界值分别为7.35 kPa、24.78、0.22；LSM值、APRI、FIB-4诊断进展期肝纤维化（S≥3）的AUC分别为0.639（95%n CI：0.446~0.832，n P = 0.134）、0.613（95%n CI：0.447~0.779，n P = 0.223）、0.587（95%n CI：0.411~0.764，n P = 0.346），最佳临界值分别为8.55 kPa、26.66、0.27。n 结论:瞬时弹性成像技术对儿童NAFLD肝纤维化有较好的诊断价值，优于APRI和FIB-4。“,”Objective:To evaluate the diagnostic value of transient elastography, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis index based on 4 factors (FIB-4) for liver fibrosis in children with non-alcoholic fatty liver disease (NAFLD).Methods:A retrospective study was conducted on 100 cases of nonalcoholic fatty liver disease in Hunan Children\'s Hospital between August 2015 to October 2020 to collect liver tissue pathological and clinical data. The receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic value of liver stiffness measurement (LSM), APRI and FIB-4 in the diagnosis of different stages of liver fibrosis caused by NAFLD in children.Results:The area under the ROC curve (AUC) value of LSM, APRI and FIB-4 for diagnosing liver fibrosis (S≥1) were 0.701 [95% confidence interval (n CI): 0.579 ~ 0.822, n P = 0.011], 0.606 (95%n CI: 0.436 ~ 0.775, n P = 0.182), and 0.568 (95%n CI: 0.397 ~ 0.740, n P = 0.387), respectively. The best cut-off values were 6.65 kPa, 21.20, and 0.18, respectively. The AUCs value of LSM, APRI, and FIB-4 for diagnosing significant liver fibrosis (S≥ 2) were 0.660 (95% n CI: 0.552 ~ 0.768, n P = 0.006), 0.578 (95% n CI: 0.464 ~ 0.691, n P = 0.182) and 0.541 (95% n CI: 0.427 ~ 0.655, n P = 0.482), respectively. The best cut-off values were 7.35kpa, 24.78 and 0.22, respectively. The AUCs value of LSM, APRI and FIB-4 for the diagnosis of advanced liver fibrosis (S≥ 3) were 0.639 (95% n CI: 0.446 ~ 0.832, n P = 0.134), 0.613 (95% n CI: 0.447 ~ 0.779, n P = 0.223) and 0.587 (95% n CI: 0.411 ~ 0.764, n P = 0.346), respectively. The best cut-off values were 8.55kpa, 26.66 and 0.27, respectively.n Conclusion:The transient elastography technique has a better diagnostic value than APRI and FIB-4 for liver fibrosis in children with NAFLD.