Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seoul, 120-752, Korea.
Dig Dis Sci. 2010 Sep;55(9):2636-43. doi: 10.1007/s10620-009-1070-3. Epub 2009 Dec 4.
To optimize management strategies and predict the long-term clinical course in patients with chronic hepatitis B (CHB), non-invasive tests to determine the degree of hepatic fibrosis have been developed.
We aimed to conduct a large-scale external validation of a simple, non-invasive test called P2/MS using CHB patients and to compare it to other non-invasive tests for the prediction of histological cirrhosis.
From 2006 to 2009, we enrolled a total of 521 consecutive CHB patients who underwent liver biopsy. Fibrosis stage was assessed according to the Metavir scoring system by a single pathologist who was unaware of the patients' histories.
For predictions of significant (p>or=2) and severe (p>or=3) fibrosis and cirrhosis (p=4), the areas under the receiver operating characteristic curves were 0.801, 0.856, and 0.906, respectively. In predicting cirrhosis, we found that diagnostic values were comparable to age-spleen platelet ratio index (0.931, p=0.063), spleen-platelet ratio index (0.923, p=0.145), age-platelet index (0.914, p=0.670), and FIB-4 (0.898. p=0.597) and had better outcomes than the aspartate aminotransferase (AST)-platelet ratio index (0.780, p<0.001), and AST-alanine aminotransferase ratio index (0.729, p<0.001). The cut-off points of P2/MS>83 and P2/MS<30 provided 91.1% of negative predictive value and 91.3% of positive predictive value, respectively. Based on these results, liver biopsies could be avoided in 67.0% of the population. These cut-offs were validated internally using bootstrap resampling methods, which showed good agreement.
P2/MS is a simple, accurate, and inexpensive method with comparable outcomes to other non-invasive tests and may reduce the need for liver biopsy in the majority of CHB patients.
为了优化慢性乙型肝炎（CHB）患者的管理策略并预测其长期临床病程，已经开发出了多种用于确定肝纤维化程度的非侵入性检测方法。
我们旨在使用 CHB 患者对一种名为 P2/MS 的简单非侵入性检测方法进行大规模的外部验证，并将其与其他用于预测组织学肝硬化的非侵入性检测方法进行比较。
我们于 2006 年至 2009 年期间共纳入了 521 例接受肝活检的连续 CHB 患者。纤维化分期按照由一位不了解患者病史的病理学家进行的 Metavir 评分系统进行评估。
对于预测显著（p>或=2）和严重（p>或=3）纤维化和肝硬化（p=4），受试者工作特征曲线下面积分别为 0.801、0.856 和 0.906。在预测肝硬化时，我们发现其诊断价值与年龄-脾血小板比指数（0.931，p=0.063）、脾血小板比指数（0.923，p=0.145）、年龄血小板指数（0.914，p=0.670）和 FIB-4（0.898，p=0.597）相当，并且优于天门冬氨酸氨基转移酶（AST）-血小板比指数（0.780，p<0.001）和 AST-丙氨酸氨基转移酶比值指数（0.729，p<0.001）。P2/MS>83 和 P2/MS<30 的截断值分别提供了 91.1%的阴性预测值和 91.3%的阳性预测值。基于这些结果，有 67.0%的人群可以避免进行肝活检。这些截断值通过 bootstrap 重采样方法进行了内部验证，结果显示具有良好的一致性。
P2/MS 是一种简单、准确且经济的方法，其结果与其他非侵入性检测方法相当，可能会减少大多数 CHB 患者进行肝活检的需求。
