Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERehd, Barcelona, Spain.
Gastroenterology. 2010 Jan;138(1):147-58.e1. doi: 10.1053/j.gastro.2009.09.047. Epub 2009 Sep 26.
BACKGROUND & AIMS: Significant fibrosis (fibrosis stage [F] >or= 2) and portal hypertension (hepatic venous pressure gradient [HVPG] >or= 6 mm Hg) in patients 1 year after liver transplantation indicate progressive hepatitis C recurrence. This study evaluated whether serum fibrosis markers can predict hepatitis C recurrence during the first year after liver transplantation.
Hyaluronic acid, amino-terminal propeptide of type-III-procollagen, tissue inhibitor of matrix metalloproteinase type-1 concentrations were measured in serum samples from 133 patients infected with hepatitis C virus (HCV) at 3, 6, and 12 months after liver transplantation; routine laboratory tests were also performed. Liver biopsy samples (n = 133) and HVPGs (n = 94) were analyzed 1 year after transplantation. Sixteen patients who were not infected with HCV served as controls.
An algorithm, including the 3 markers (3-M-ALG) and 3 published scores (aspartate aminotransferase [AST]-to-alanine aminotransferase ratio, AST-to-platelet ratio index, and Benlloch) were analyzed. One year after liver transplantation, 50 patients (38%) had significant fibrosis (F >or= 2) and 31 (32%) had an HVPG >or= 6 mm Hg. The area under the receiver operator characteristic curve of the 3-M-ALG used to identify F >or= 2 at 3, 6, and 12 months after transplantation (0.67, 0.77, and 0.78) and of those with HVPG >or= 6 at the same time points (0.75, 0.87, and 0.90) were significantly higher than values obtained with the 3 published scores. At 12 months, a 3-M-ALG >or= 2 identified most patients at risk of decompensation/death.
Serum markers can accurately discriminate between patients with mild and progressive hepatitis C recurrence after liver transplantation.
肝移植 1 年后出现显著纤维化（纤维化分期[F]≥2）和门静脉高压症（肝静脉压力梯度[HVPG]≥6mmHg）提示丙型肝炎复发进展。本研究评估了血清纤维化标志物是否可以预测肝移植后 1 年内丙型肝炎的复发。
对 133 例丙型肝炎病毒（HCV）感染患者肝移植后 3、6 和 12 个月的血清样本进行透明质酸、III 型前胶原氨基端肽、基质金属蛋白酶组织抑制剂-1 浓度检测；同时进行常规实验室检查。对移植后 1 年的肝活检样本（n=133）和 HVPG（n=94）进行分析。16 例未感染 HCV 的患者作为对照。
分析了包括 3 种标志物（3-M-ALG）和 3 种已发表评分（天门冬氨酸氨基转移酶[AST]与丙氨酸氨基转移酶比值、AST 与血小板比值指数和 Benlloch）在内的算法。肝移植后 1 年，50 例（38%）患者出现显著纤维化（F≥2），31 例（32%）患者 HVPG≥6mmHg。3-M-ALG 用于识别移植后 3、6 和 12 个月 F≥2 的受试者工作特征曲线下面积（0.67、0.77 和 0.78）和用于识别同一时间点 HVPG≥6 的患者的曲线下面积（0.75、0.87 和 0.90）显著高于 3 种已发表评分的曲线下面积。在 12 个月时，3-M-ALG≥2 可识别出大多数有失代偿/死亡风险的患者。
血清标志物可准确区分肝移植后丙型肝炎复发的轻度和进展型患者。
