Université Libre de Bruxelles, Brussels, Belgium.
J Hepatol. 2011 Jul;55(1):38-44. doi: 10.1016/j.jhep.2010.10.018. Epub 2010 Nov 23.
BACKGROUND & AIMS: Fibrosis progression in patients with chronic hepatitis C (CHC) is highly variable. A Cirrhosis Risk Score (CRS) based on seven genetic variants has been recently developed for identifying patients at risk for cirrhosis. The objective of this study was to assess the role of the CRS for the early prediction of fibrosis progression in CHC patients with mild liver fibrosis. In addition, we evaluated the potential benefit, for prediction accuracy, of a recently described non-invasive fibrosis staging assay, the Enhanced Liver Fibrosis (ELF) test.
Two separate cohorts of HCV patients (Brussels, Belgium/Hannover, Germany) were retrospectively analyzed. Only patients with a fibrosis Ishak or METAVIR score of F0-F1 at baseline were included. Patients were classified as progressors if they showed an increase ≥2 fibrosis stages at the second histological evaluation after a follow-up ≥5years. The CRS was calculated locally. Genotyping was performed by PCR and oligonucleotide ligation with the resulting signal detected with a Luminex® 200TM and computer analysis.
In Brussels, 12/25 patients progressed (48%); similarly in Hannover, 16/31 (52%) patients progressed. In both sample sets, the CRS was significantly associated with fibrosis progression (p=0.050 in Brussels; p=0.018 in Hannover). The ELF test was only a significant predictor in Hannover (p=0.015). In multivariate analysis the CRS remained the only variable associated with fibrosis progression (odds-ratio=2.23, 95%CI 1.21-4.11 p=0.01).
Although conducted on a limited number of patients, this study in two independent centres confirms that the CRS predicts fibrosis progression in initially mild CHC.
慢性丙型肝炎（CHC）患者的纤维化进展具有高度变异性。最近开发了一种基于七个遗传变异的肝硬化风险评分（CRS），用于识别肝硬化风险患者。本研究的目的是评估 CRS 在预测轻度肝纤维化的 CHC 患者纤维化进展中的作用。此外，我们评估了最近描述的一种非侵入性纤维化分期检测，即增强型肝脏纤维化（ELF）检测，对预测准确性的潜在益处。
对两个独立的 HCV 患者队列（比利时布鲁塞尔/德国汉诺威）进行回顾性分析。仅纳入基线时纤维化 Ishak 或 METAVIR 评分为 F0-F1 的患者。如果患者在第二次组织学评估时显示纤维化分期增加≥2 期，且随访时间≥5 年，则将其归类为进展者。CRS 是在当地计算的。基因分型通过 PCR 和寡核苷酸连接进行，通过 Luminex® 200TM 和计算机分析检测到的信号进行检测。
在布鲁塞尔，25 例患者中有 12 例（48%）进展；在汉诺威，31 例患者中有 16 例（52%）进展。在两个样本组中，CRS 与纤维化进展显著相关（p=0.050 在布鲁塞尔；p=0.018 在汉诺威）。ELF 试验仅在汉诺威是纤维化进展的显著预测因素（p=0.015）。在多变量分析中，CRS 仍然是与纤维化进展相关的唯一变量（优势比=2.23，95%CI 1.21-4.11，p=0.01）。
尽管本研究纳入的患者数量有限，但在两个独立中心进行的这项研究证实，CRS 可预测最初轻度 CHC 的纤维化进展。
