Schiavon Leonardo L, Schiavon Janaína L N, Filho Roberto J Carvalho, Sampaio Juliana P, Lanzoni Valéria P, Silva Antonio Eduardo B, Ferraz Maria Lucia G
Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil.
Hepatology. 2007 Aug;46(2):307-14. doi: 10.1002/hep.21681.
HCV infection is common among patients with end-stage renal disease (ESRD) on hemodialysis, and it has been considered an independent risk factor for mortality in this setting. Although liver biopsy in ESRD patients with HCV infection is useful before kidney transplantation, it carries a high risk of complications. We sought to assess the diagnostic value of noninvasive markers to stage liver fibrosis in 203 ESRD HCV-infected patients. Univariate and multivariate analysis were used to identify variables associated with significant fibrosis (METAVIR F2, F3, or F4 stages). Significant liver fibrosis was observed in 48 patients (24%). Logistic regression analysis identified AST and platelet count as independent predictors of significant fibrosis (P < 0.001 and P = 0.001, respectively). The area under the receiver operating characteristic curve of the AST to platelet ratio index (APRI) for predicting significant fibrosis was 0.801. An APRI < 0.40 accurately identified patients with fibrosis stage 0 or 1 in 93% of the cases (NPV = 93%), and all misclassified subjects were F2. A cutoff > or = 0.95 to confirm significant fibrosis had a PPV of 66%. If biopsy indication was restricted to APRI scores in the intermediate range (> or = 0.40 and < 0.95), 52% of liver biopsies could have been correctly avoided.
Stage of liver fibrosis can be reliably predicted in ESRD HCV-infected subjects by simple and widely available blood tests such as AST levels and platelet count. These tests might obviate the requirement for a liver biopsy in a significant proportion of those patients.
丙型肝炎病毒（HCV）感染在接受血液透析的终末期肾病（ESRD）患者中很常见，并且在这种情况下它被认为是死亡的独立危险因素。尽管对于感染HCV的ESRD患者，肝活检在肾移植前是有用的，但它具有较高的并发症风险。我们试图评估203例感染HCV的ESRD患者中无创性标志物对肝纤维化分期的诊断价值。采用单因素和多因素分析来确定与显著纤维化（METAVIR F2、F3或F4期）相关的变量。48例患者（24%）观察到显著肝纤维化。逻辑回归分析确定天冬氨酸转氨酶（AST）和血小板计数是显著纤维化的独立预测因素（分别为P < 0.001和P = 0.001）。AST与血小板比值指数（APRI）预测显著纤维化的受试者工作特征曲线下面积为0.801。APRI < 0.40在93%的病例中准确识别出纤维化0期或1期的患者（阴性预测值 = 93%），所有误分类的受试者均为F2期。确认显著纤维化的临界值>或 = 0.95时，阳性预测值为66%。如果将肝活检指征限制在APRI评分的中间范围（>或 = 0.40且< 0.95），52%的肝活检本可正确避免。
通过简单且广泛可用的血液检测，如AST水平和血小板计数，可可靠地预测感染HCV的ESRD受试者的肝纤维化分期。这些检测可能会使很大一部分此类患者无需进行肝活检。
