Hospital Clinic, IDIBAPS and Ciberehd, Barcelona, Spain.
Aliment Pharmacol Ther. 2011 Jan;33(1):138-48. doi: 10.1111/j.1365-2036.2010.04500.x. Epub 2010 Oct 26.
Liver biopsy is the reference standard to assess liver fibrosis in chronic hepatitis C.
To validate and compare the diagnostic performance of non-invasive tests for prediction of liver fibrosis severity and assessed changes in extracellular matrix markers after antiviral treatment.
The performances of Forns' score, AST to platelet ratio index (APRI), FIB-4 index and Enhanced Liver Fibrosis (ELF) score were validated in 340 patients who underwent antiviral therapy. These scores were determined 24 weeks after treatment in 161 patients.
Forns' score, APRI, FIB-4 and ELF score showed comparable diagnostic accuracies for significant fibrosis [area under the receiver operating characteristic curve (AUROC) 0.83, 0.83, 0.85 and 0.81, respectively]. To identify cirrhosis, FIB-4 index showed a significantly better performance over APRI and ELF score (AUROC 0.89 vs. 0.83 and 0.82, respectively). ELF score decreased significantly in patients with sustained virological response (SVR) (P < 0.0001) but remained unchanged in nonresponders. Non-1 hepatitis C virus (HCV) genotype, baseline lower HCV RNA, glucose, hyaluronic acid and higher cholesterol levels were independently associated with SVR.
Simple panel markers and ELF score are accurate at identifying significant fibrosis and cirrhosis in chronic hepatitis C. A decrease in ELF score after antiviral treatment reflects the impact of viral clearance in hepatic extracellular matrix and probably in the improvement of liver fibrosis.
肝活检是评估慢性丙型肝炎肝纤维化的参考标准。
验证和比较非侵入性检测预测肝纤维化严重程度的诊断性能，并评估抗病毒治疗后细胞外基质标志物的变化。
在 340 名接受抗病毒治疗的患者中验证了 Forns 评分、天冬氨酸转氨酶与血小板比值指数（APRI）、FIB-4 指数和增强型肝脏纤维化（ELF）评分的性能。在 161 名患者中，这些评分在治疗后 24 周确定。
Forns 评分、APRI、FIB-4 和 ELF 评分对显著纤维化的诊断准确性相当[受试者工作特征曲线下面积（AUROC）分别为 0.83、0.83、0.85 和 0.81]。为了识别肝硬化，FIB-4 指数在 AUROC 方面优于 APRI 和 ELF 评分（分别为 0.89 与 0.83 和 0.82）。在持续病毒学应答（SVR）患者中，ELF 评分显著下降（P<0.0001），但在无应答者中无变化。非 1 型丙型肝炎病毒（HCV）基因型、基线较低的 HCV RNA、葡萄糖、透明质酸和较高的胆固醇水平与 SVR 独立相关。
简单的组合标志物和 ELF 评分可准确识别慢性丙型肝炎中的显著纤维化和肝硬化。抗病毒治疗后 ELF 评分降低反映了病毒清除对肝细胞外基质的影响，可能改善了肝纤维化。
