Sterling Richard K, Lissen Eduardo, Clumeck Nathan, Sola Ricard, Correa Mendes Cassia, Montaner Julio, S Sulkowski Mark, Torriani Francesca J, Dieterich Doug T, Thomas David L, Messinger Diethelm, Nelson Mark
Section of Hepatology, Virginia Commonwealth University Health System, Richmond, VA 23298-0341, USA.
Hepatology. 2006 Jun;43(6):1317-25. doi: 10.1002/hep.21178.
Liver biopsy remains the gold standard in the assessment of severity of liver disease. Noninvasive tests have gained popularity to predict histology in view of the associated risks of biopsy. However, many models include tests not readily available, and there are limited data from patients with HIV/hepatitis C virus (HCV) coinfection. We aimed to develop a model using routine tests to predict liver fibrosis in patients with HIV/HCV coinfection. A retrospective analysis of liver histology was performed in 832 patients. Liver fibrosis was assessed via Ishak score; patients were categorized as 0-1, 2-3, or 4-6 and were randomly assigned to training (n = 555) or validation (n = 277) sets. Multivariate logistic regression analysis revealed that platelet count (PLT), age, AST, and INR were significantly associated with fibrosis. Additional analysis revealed PLT, age, AST, and ALT as an alternative model. Based on this, a simple index (FIB-4) was developed: age ([yr] x AST [U/L]) / ((PLT [10(9)/L]) x (ALT [U/L])(1/2)). The AUROC of the index was 0.765 for differentiation between Ishak stage 0-3 and 4-6. At a cutoff of <1.45 in the validation set, the negative predictive value to exclude advanced fibrosis (stage 4-6) was 90% with a sensitivity of 70%. A cutoff of >3.25 had a positive predictive value of 65% and a specificity of 97%. Using these cutoffs, 87% of the 198 patients with FIB-4 values outside 1.45-3.25 would be correctly classified, and liver biopsy could be avoided in 71% of the validation group. In conclusion, noninvasive tests can accurately predict hepatic fibrosis and may reduce the need for liver biopsy in the majority of HIV/HCV-coinfected patients.
肝活检仍是评估肝病严重程度的金标准。鉴于活检存在相关风险，非侵入性检测在预测组织学方面越来越受欢迎。然而，许多模型包含的检测方法不易获得，且关于人类免疫缺陷病毒（HIV）/丙型肝炎病毒（HCV）合并感染患者的数据有限。我们旨在开发一种使用常规检测来预测HIV/HCV合并感染患者肝纤维化的模型。对832例患者的肝脏组织学进行了回顾性分析。通过Ishak评分评估肝纤维化；患者被分为0 - 1级、2 - 3级或4 - 6级，并随机分配到训练组（n = 555）或验证组（n = 277）。多变量逻辑回归分析显示，血小板计数（PLT）、年龄、谷草转氨酶（AST）和国际标准化比值（INR）与纤维化显著相关。进一步分析显示PLT、年龄、AST和谷丙转氨酶（ALT）可作为替代模型。基于此，开发了一个简单指数（FIB - 4）：年龄（[岁]×AST [U/L]）/（（PLT [10⁹/L]）×（ALT [U/L]）¹/²）。该指数区分Ishak分期0 - 3级和4 - 6级的曲线下面积（AUROC）为0.765。在验证组中，截断值<1.45时，排除晚期纤维化（4 - 6期）的阴性预测值为90%，敏感性为70%。截断值>3.25时，阳性预测值为65%，特异性为97%。使用这些截断值，198例FIB - 4值在1.45 - 3.25范围之外的患者中有87%可被正确分类，并且验证组中71%的患者可避免肝活检。总之，非侵入性检测可准确预测肝纤维化，并可能减少大多数HIV/HCV合并感染患者的肝活检需求。
