慢性丙型肝炎患者肝纤维化评估中肝活检与纤维检测的相关性

Correlation between liver biopsy and fibrotest in the evaluation of hepatic fibrosis in patients with chronic hepatitis C.

作者信息

Said Yosra, Salem Mohamed, Mouelhi Leila, Mekki Heifa, Houissa Fatma, Ben Rejeb Majd, Moussa Amel, Trabelsi Senda, Debbeche Radhouane, Bouzaidi Slim, Najjar Taoufik

机构信息

Service de Gastroentérologie et d'hépatologie, Hôpital Charles Nicolle, Tunis, Tunisie.

出版信息

Tunis Med. 2010 Aug;88(8):573-8.

PMID:20711964

Abstract

AIM

To assess the diagnostic value of Fibrotest in comparison with liver biopsy, for the evaluation of hepatic fibrosis in patients with chronic hepatitis C.

METHODS

This prospective study included in 2 years (2006-2007), consecutive patients with chronic hepatitis C naive to treatment. Fibrotest and liver biopsy were performed. Receiver operating characteristics (ROC) curves , the sensitivity, specificity, positive and negative predictive values were used to assess the diagnostic value of Fibrotest in comparison with the METAVIR classification.

RESULTS

We recruited a total of 65 patients: 28 males and 37 females (mean age: 50 years); 92% of the patients had genotype 1. The histological fibrosis results were: 3.1% F0; 24.6% F1; 32.3% F2; 29.2% F3 and 10.8 % F4. The diagnostic value of Fibrotest in the detection of significant fibrosis (F2-F4) was 0. 87. A score > 0.5 has a sensitivity of 85. 1%, a specificity of 72. 2%, a positive predictive value of 88. 9%,and a negative predictive value of 65%. The diagnostic value of Fibrotest in the detection of cirrhosis (F4) was 0. 85. There were 13/65 cases of discordance (20%) for fibrosis, 4 cases were attributable to biopsy and 6 cases to Fibrotest. The discordance was unexplained in 3 cases. the size of biopsy< 15 mm [OR=2. 82, 95% CI, 1. 3-6. 07; p = 0. 008] and the stage of fibrosis F0, F1, F2 [OR =3. 35 , 95% CI, 1. 1-10. 2; p=0. 03] were considered as risk factors of discordance in multivariate analysis.

CONCLUSION

This prospective study confirmed the good diagnostic value of Fibrotest as compared with the histological analysis of liver biopsy.

摘要

目的

评估Fibrotest相对于肝活检在评估慢性丙型肝炎患者肝纤维化方面的诊断价值。

方法

这项前瞻性研究纳入了2006年至2007年连续的初治慢性丙型肝炎患者。进行了Fibrotest和肝活检。采用受试者操作特征（ROC）曲线、敏感度、特异度、阳性预测值和阴性预测值来评估Fibrotest相对于METAVIR分类的诊断价值。

结果

我们共招募了65例患者：男性28例，女性37例（平均年龄：50岁）；92%的患者为基因1型。组织学纤维化结果为：F0占3.1%；F1占24.6%；F2占32.3%；F3占29.2%；F4占10.8%。Fibrotest检测显著纤维化（F2 - F4）的诊断价值为0.87。评分>0.5时，敏感度为85.1%，特异度为72.2%，阳性预测值为88.9%，阴性预测值为65%。Fibrotest检测肝硬化（F4）的诊断价值为0.85。纤维化方面有13/65例不一致（20%），4例归因于活检，6例归因于Fibrotest。3例不一致原因不明。活检标本大小<15 mm[比值比（OR）=2.82，95%可信区间（CI），1.3 - 6.07；P = 0.008]以及纤维化分期F0、F1、F2[OR = 3.35，95%CI，1.1 - 10.2；P = 0.03]在多因素分析中被视为不一致的危险因素。