通过一种新的非侵入性指数（HGM-3 指数）诊断 HIV 和丙型肝炎病毒合并感染患者的晚期纤维化。

Diagnosis of advanced fibrosis in HIV and hepatitis C virus-coinfected patients via a new noninvasive index: the HGM-3 index.

机构信息

Laboratory of Molecular Epidemiology of Infectious Diseases, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.

出版信息

HIV Med. 2010 Jan;11(1):64-73. doi: 10.1111/j.1468-1293.2009.00745.x. Epub 2009 Aug 3.

DOI:10.1111/j.1468-1293.2009.00745.x

PMID:19686437

Abstract

BACKGROUND

Noninvasive tests are increasingly being used for the assessment of liver fibrosis. We aimed to develop a serum index for the identification of advanced fibrosis (F>or=3) in HIV/hepatitis C virus (HCV)-coinfected patients.

METHODS

We carried out a cross-sectional study on a group of 195 patients comprised of an estimation group (EG; n=127) and a validation group (VG; n=68) who all underwent liver biopsy and had not received previous interferon therapy. Liver fibrosis was estimated using the METAVIR score. We developed a new serum index (HGM-3) dependent on levels of platelets, alkaline phosphatase, hepatic growth factor, tissue inhibitor of metalloproteinase-1 and hyaluronic acid.

RESULTS

In the EG, the area under the receiver operating characteristic curve (AUC-ROC) of HGM-3 for identification of F>or=3 was 0.939 [95% confidence interval (CI) 0.899, 0.979] which was significantly higher than the AUC-ROC of the HGM-2, FIB-4, aspartate aminotransferase to platelet ratio (APRI) and Forns' indexes. With HGM-3 <0.135 for F<3, 57 patients were correctly identified and two patients were misclassified. We found the presence of F<3 with 96.6% certainty. The negative likelihood ratio (LR) was <0.1 and the diagnostic odds ratio (DOR) was >40. With HGM-3 >0.570 in the EG for F>or=3, 31 patients were correctly identified, and five patients were misclassified. We found the presence of F>or=3 with 86.1% certainty. The positive LR was >12 and the DOR was >40. For the VG, the diagnostic accuracy values were similar to the values for the EG.

CONCLUSIONS

HGM-3 appears to be an accurate noninvasive method for the diagnosis of bridging fibrosis and cirrhosis in HIV/HCV-coinfected patients.

摘要

背景

非侵入性检测越来越多地用于评估肝纤维化。我们旨在为 HIV/丙型肝炎病毒（HCV）合并感染患者开发一种用于识别晚期纤维化（F>or=3）的血清指标。

方法

我们对一组 195 名患者进行了横断面研究，其中包括一个估计组（EG；n=127）和一个验证组（VG；n=68），所有患者均接受了肝活检且未接受过干扰素治疗。使用 METAVIR 评分评估肝纤维化。我们开发了一种新的血清指数（HGM-3），依赖于血小板、碱性磷酸酶、肝生长因子、金属蛋白酶组织抑制剂-1 和透明质酸的水平。

结果

在 EG 中，HGM-3 用于识别 F>or=3 的受试者工作特征曲线（ROC）下面积（AUC-ROC）为 0.939[95%置信区间（CI）0.899，0.979]，显著高于 HGM-2、FIB-4、天冬氨酸氨基转移酶与血小板比值（APRI）和福恩斯指数的 AUC-ROC。当 HGM-3<0.135 时，F<3 的患者中有 57 例被正确识别，有 2 例被误诊。我们以 96.6%的置信度确定了 F<3 的存在。阴性似然比（LR）<0.1，诊断比值比（DOR）>40。在 EG 中，当 HGM-3>0.570 时，F>or=3 的患者中有 31 例被正确识别，有 5 例被误诊。我们以 86.1%的置信度确定了 F>or=3 的存在。阳性 LR>12，DOR>40。对于 VG，诊断准确性值与 EG 相似。