HIFIH Laboratory, IFR 132, University, PRES UNAM, Angers, France.
Liver Int. 2009 Nov;29(10):1507-15. doi: 10.1111/j.1478-3231.2009.02101.x. Epub 2009 Sep 2.
Blood tests and liver stiffness evaluation (LSE) by ultrasonographic elastometry are accurate tools for diagnosing liver fibrosis. We evaluated whether their synchronous combination in new scores could improve the diagnostic accuracy and reduce liver biopsy requirement in algorithm.
Three hundred and ninety patients with chronic liver disease of miscellaneous causes were included. Five blood fibrosis tests were evaluated: APRI, FIB-4, Hepascore, Fibrotest and FibroMeter. The reference was fibrosis Metavir staging.
Diagnosis of significant fibrosis (Metavir F>or=2). The most accurate synchronous combination was FibroMeter+LSE, which provided a significantly higher area under the receiver operating characteristic curve (0.892) than LSE alone (0.867, P=0.011) or Fibrometer (0.834, P<10(-3)). An algorithm using the FibroMeter+LSE combination and then a liver biopsy in indeterminate cases had 91.9% diagnostic accuracy and required significantly fewer biopsies (20.2%) than previously published Bordeaux algorithm (28.6%, P=0.02) or sequential algorithm for fibrosis evaluation (SAFE) (55.7%, P<10(-3)). The Angers algorithm performance was not significantly different between viral hepatitis and other causes. Diagnosis of cirrhosis. The most accurate synchronous combination was LSE+FibroMeter, which provided >or=90% predictive values for cirrhosis in 90.6% of patients vs 87.4% for LSE (P=0.02) and 57.9% for FibroMeter (P<10(-3)). An algorithm including the LSE+FibroMeter combination, and then a liver biopsy in indeterminate cases, had a significantly higher diagnostic accuracy than the SAFE algorithm (91.0 vs 79.8%, P<10(-3)), and required significantly fewer biopsies than the Bordeaux algorithm (9.3 vs 25.3%, P<10(-3)).
The synchronous combination of a blood test plus LSE improves the accuracy of the non-invasive diagnosis of liver fibrosis and, consequently, markedly decreases the biopsy requirement in the diagnostic algorithm, notably to <10% in cirrhosis diagnosis.
血液检测和超声弹性成像肝脏硬度评估（LSE）是诊断肝纤维化的准确工具。我们评估了在新的评分系统中同步结合这两种方法是否能提高诊断准确性并减少肝活检的需求。
共纳入 390 例原因不明的慢性肝病患者。评估了 5 种血液纤维化检测方法：APRI、FIB-4、Hepascore、Fibrotest 和 FibroMeter。参考标准为纤维化 Metavir 分期。
诊断显著纤维化（Metavir F≥2）。最准确的同步组合是 FibroMeter+LSE，其受试者工作特征曲线下面积（0.892）显著高于单独使用 LSE（0.867，P=0.011）或 FibroMeter（0.834，P＜10(-3)）。在不确定的病例中使用 FibroMeter+LSE 组合并进行肝活检的算法诊断准确率为 91.9%，活检数量明显少于之前发表的波尔多算法（28.6%，P=0.02）或纤维化评估序贯算法（SAFE）（55.7%，P＜10(-3)）。Angers 算法在病毒性肝炎和其他原因引起的肝纤维化中的性能无显著差异。诊断肝硬化。最准确的同步组合是 LSE+FibroMeter，在 90.6%的患者中，该组合对肝硬化的预测值均大于或等于 90%，而 LSE 为 87.4%（P=0.02），FibroMeter 为 57.9%（P＜10(-3)）。包括 LSE+FibroMeter 组合的算法，然后对不确定的病例进行肝活检，其诊断准确性显著高于 SAFE 算法（91.0 vs 79.8%，P＜10(-3)），活检数量明显少于波尔多算法（9.3 vs 25.3%，P＜10(-3)）。
血液检测和 LSE 的同步结合提高了肝纤维化无创诊断的准确性，从而显著减少了诊断算法中的活检需求，尤其是在肝硬化诊断中，需求降至 10%以下。
