Department of Nephrology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Nephron Clin Pract. 2011;117(3):c289-95. doi: 10.1159/000320751. Epub 2010 Sep 18.
Liver biopsy is an imperfect gold standard for assessing the disease severity in hemodialysis patients with chronic hepatitis C. Our purpose was to compare the accuracy of the FibroTest (FT) and ActiTest (AT) with liver biopsy and the AST-to-platelet ratio index (APRI) in determining hepatic fibrosis and necroinflammatory activity in hemodialysis patients with hepatitis C virus (HCV).
The FT-AT index combining 6 biochemical markers was assessed in 33 hemodialysis patients with HCV. Liver fibrosis and necroinflammatory activity was staged and graded according to the METAVIR scoring system.
The accuracy of FT-AT versus biopsy was 0.46 for significant fibrosis and 0.36 for severe necroinflammatory activity. The FT index had a positive predictive value of 20% for scores greater than 0.6 and a negative predictive value of 45% for scores less than 0.2. Eleven of the 33 patients had scores ≤0.2, 6 had significant fibrosis on biopsy. Four out of 5 patients with FT scores >0.6 had mild fibrosis. APRI correlated well with the biopsy.
The FT-AT test does not seem to be a reliable noninvasive marker for the prediction of necroinflammatory activity and fibrosis in hemodialysis patients with HCV and cannot be used as an alternative to either liver biopsy or APRI.
肝活检是评估慢性丙型肝炎血液透析患者疾病严重程度的不完美金标准。我们的目的是比较 FibroTest（FT）和 ActiTest（AT）与肝活检和天冬氨酸转氨酶-血小板比值指数（APRI）在确定丙型肝炎病毒（HCV）血液透析患者肝纤维化和坏死性炎症活动中的准确性。
评估了 33 例 HCV 血液透析患者的 6 种生化标志物组合的 FT-AT 指数。根据 METAVIR 评分系统对肝纤维化和坏死性炎症活动进行分期和分级。
FT-AT 与活检相比，对显著纤维化的准确性为 0.46，对严重坏死性炎症活动的准确性为 0.36。FT 指数对评分大于 0.6 的阳性预测值为 20%，对评分小于 0.2 的阴性预测值为 45%。33 例患者中有 11 例评分≤0.2，6 例活检有显著纤维化。FT 评分>0.6 的 5 例患者中有 4 例为轻度纤维化。APRI 与活检相关性良好。
FT-AT 试验似乎不能作为预测 HCV 血液透析患者坏死性炎症活动和纤维化的可靠非侵入性标志物，不能替代肝活检或 APRI。
