对于慢性肝炎患者，是否存在任何非侵入性标志物可替代肝穿刺活检来预测肝纤维化？

Is there any non-invasive marker replace the needle liver biopsy predictive for liver fibrosis, in patients with chronic hepatitis?

作者信息

Vardar Rukiye, Vardar Enver, Demiri Sibel, Sayhan S Emil, Bayol Umit, Yildiz Coşkun, Postaci Hakan

机构信息

Department of Gastroenterology, Ege University, Izmir, Turkey.

出版信息

Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1459-65.

PMID:19950810

Abstract

BACKGROUND/AIMS: Non-invasive serum markers are being used to determine fibrosis score as an alternative to liver biopsy. The aim of the present study was to evaluate the accuracy and predictive value of the non-invasive markers in identifying the presence or absence of significant fibrosis in patients with chronic viral hepatitis.

METHODOLOGY

A total of 557 patients (401 chronic hepatitis B (CHB), 156 chronic hepatitis C (CHC)) were enrolled into the study retrospectively. Liver biopsies were evaluated histopathologically according to the Knodell scoring system. Laboratory values such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), y-glutamyltranspeptidase (GGT) and platelet count (PLT) was tested on the same day of liver biopsy. Using these laboratory values, AST/ALT ratio (AAR), age-platelet index (API) and AST/ PLT ratio index (APRI), GGT/PLT ratio index (GAPI) and AST to GGT ratio (AGR) were calculated.

RESULTS

Advanced liver fibrosis including stage 3-4 was observed in 197 (49%) of patients with CHB, 84 (54%) of patients with CHC. Mean age and GGT were higher and PLT was lower in patients with advanced liver fibrosis (stage 3-4) than those in patients with absence of significant fibrosis (stage 0-1) (p < 0.001). But, there was no statistically significant relationship for mean value of AST and ALT between patients with stage 0-1 and stage 3-4. The API and GAPI were found to be significantly associated with the fibrosis score and correlation co-efficient (r) were 0.35 and 0.23, respectively (p < 0.001), while the APRI, AAR and AGR values were not associated with the fibrosis score in all of the patients (p > 0.05). But, APRI has showed correlation with liver fibrosis in patients with CHC contrary to patients with CHB.

CONCLUSION

Age, GGT, PLT, API and GAPI are significantly associated with the extent of fibrosis. But these non-invasive markers can not replace liver biopsy.

摘要

背景/目的：非侵入性血清标志物正被用于确定纤维化评分，以替代肝活检。本研究的目的是评估这些非侵入性标志物在识别慢性病毒性肝炎患者是否存在显著纤维化方面的准确性和预测价值。

方法

本研究共纳入557例患者（401例慢性乙型肝炎（CHB），156例慢性丙型肝炎（CHC）），进行回顾性研究。根据Knodell评分系统对肝活检标本进行组织病理学评估。在肝活检当天检测天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、γ-谷氨酰转肽酶（GGT）和血小板计数（PLT）等实验室指标。利用这些实验室指标计算AST/ALT比值（AAR）、年龄-血小板指数（API）、AST/PLT比值指数（APRI）、GGT/PLT比值指数（GAPI）和AST与GGT比值（AGR）。

结果

197例（49%）CHB患者和84例（54%）CHC患者出现3-4期的晚期肝纤维化。晚期肝纤维化（3-4期）患者的平均年龄和GGT水平较高，PLT水平较低，与无显著纤维化（0-1期）患者相比差异有统计学意义（p<0.001）。但是，0-1期和3-4期患者的AST和ALT平均值之间无统计学显著关系。发现API和GAPI与纤维化评分显著相关，相关系数（r）分别为0.35和0.23（p<0.001），而APRI、AAR和AGR值在所有患者中均与纤维化评分无关（p>0.05）。但是，与CHB患者相反，APRI在CHC患者中与肝纤维化显示出相关性。