Hsieh Yung-Yu, Tung Shui-Yi, Lee I-Lin, Lee Kamfai, Shen Chien-Heng, Wei Kuo-Liang, Chang Te-Sheng, Chuang Chia-Sheng, Wu Cheng-Shyong, Lin Yi-Hsiung
Department of Gastroenterolgy and Hepatology, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2009 Nov-Dec;32(6):614-22.
Liver biopsy-the gold standard in assessing liver histology-is recommended before all antiviral treatment. However, this procedure may cause complications, is costly, and is limited by sampling errors. Hence, noninvasive tests have been proposed to assess the severity of hepatic fibrosis. We propose a novel noninvasive index for predicting liver fibrosis, named fibro-quotient (FibroQ), and compared the diagnostic accuracies of FibroQ, aspartate aminotransferase (AST)-to-platelet ratio index (APRI), and AST/alanine aminotransferase (ALT) ratio (AAR).
This retrospective cohort study included 140 consecutive patients with chronic viral hepatitis who had undergone percutaneous liver biopsy before treatment at the Chang Gung Memorial Hospital, Chiayi from May 2005 through December 2007. The clinical data including sex, age, AST, ALT, platelet count, prothrombin time (PT) international normalized ratio (INR), and the Metavir fibrosis score (F0 to F4) of liver histology were recorded. APRI, AAR, and FibroQ were calculated. Receiver operating characteristic (ROC) curves were constructed to compare the accuracies of these three noninvasive tests in predicting significant fibrosis in patients with chronic viral hepatitis.
FibroQ performed better than APRI, but was equal to AAR, in the prediction of significant fibrosis [area under the receiver operating characteristic curve (AUC): 0.783 vs 0.631 (p = 0.02) and 0.783 vs 0.733 (p = 0.26), respectively] and cirrhosis (AUC: 0.791 vs 0.634 (p = 0.03), and 0.791 vs 0.782 (p= 0.47), respectively). Using FibroQ below the lower cutoff value (0.6) and above the higher cutoff value (1.6), 108 of 140 (77.1%) patients could be identified correctly to have or not have significant fibrosis.
FibroQ, a novel noninvasive test, is an useful and easy tool to evaluate liver fibrosis in patients with chronic viral hepatitis and has better accuracy than APRI and is equal to AAR. Further prospective studies are warranted to validate its efficacy.
肝活检是评估肝脏组织学的金标准，建议在所有抗病毒治疗前进行。然而，该操作可能会引起并发症，成本高昂，且受抽样误差限制。因此，已提出非侵入性检测方法来评估肝纤维化的严重程度。我们提出了一种预测肝纤维化的新型非侵入性指标，称为纤维化商数（FibroQ），并比较了FibroQ、天冬氨酸转氨酶（AST）与血小板比值指数（APRI）以及AST/丙氨酸转氨酶（ALT）比值（AAR）的诊断准确性。
这项回顾性队列研究纳入了2005年5月至2007年12月期间在嘉义长庚纪念医院接受治疗前进行经皮肝活检的140例连续慢性病毒性肝炎患者。记录临床数据，包括性别、年龄、AST、ALT、血小板计数、凝血酶原时间（PT）国际标准化比值（INR）以及肝脏组织学的梅塔维纤维化评分（F0至F4）。计算APRI、AAR和FibroQ。构建受试者操作特征（ROC）曲线，以比较这三种非侵入性检测方法预测慢性病毒性肝炎患者显著纤维化的准确性。
在预测显著纤维化方面，FibroQ的表现优于APRI，但与AAR相当[受试者操作特征曲线下面积（AUC）：分别为0.783对0.631（p = 0.02）和0.783对0.733（p = 0.26）]，在预测肝硬化方面（AUC：分别为0.791对0.634（p = 0.03）和0.791对0.782（p = 0.47）]。使用低于下限值（0.6）和高于上限值（1.6）的FibroQ，140例患者中有108例（77.1%）能够被正确识别为有或无显著纤维化。
FibroQ是一种新型非侵入性检测方法，是评估慢性病毒性肝炎患者肝纤维化的有用且简便的工具，其准确性优于APRI且与AAR相当。需要进一步的前瞻性研究来验证其有效性。
