Omran Mohamed M, Farid Khaled, Emran Tarek M, Attallah Ahmed A
Research and Development Department, Biotechnology Research Center, New Damietta, Egypt.
Arab J Gastroenterol. 2011 Jun;12(2):74-9. doi: 10.1016/j.ajg.2011.04.006. Epub 2011 May 17.
Non-invasive methods for the assessment of liver fibrosis are clinically important where hepatitis C virus (HCV) is common in Egypt. Our aim was to evaluate the diagnostic performance of a panel of simple blood markers of liver fibrosis in chronic hepatitis C (CHC) patients.
A total of 199 patients with CHC evaluated for eligibility for antiviral therapy were included. Liver biochemical profile including transaminases, bilirubin, alkaline phosphatase, serum albumin, complete blood count prothrombin time and AFP were estimated. Liver biopsy was done. Statistical analyses were performed by logistic regression and receiver operating characteristic (ROC) curves to assess and compare diagnostic accuracy of blood markers. A stepwise combination algorithm was developed and validated prospectively in 135 additional patients.
α-Foetoprotein (AFP) was the most efficient marker among other markers tested. The areas under the curves (AUCs) of AFP were 0.77 for significant liver fibrosis (F2-F4), 0.75 for advanced liver fibrosis (F3-F4) and 0.76 for liver cirrhosis (F4). The stepwise multivariate discriminant analysis (MDA) selected a novel non-invasive index for discriminating patients with significant liver fibrosis, named Fibro-α score. Fibro-α score=(1.35 (numeric constant) +AFP (IUml(-1))×0.009584+aspartate aminotransferase (AST)/alanine aminotransferase (ALT)×0.243-platelet count (×10(9)l(-1))×0.001624). The Fibro-α score was used for patients with advanced liver fibrosis and liver cirrhosis. The AUCs of Fibro-α score were 0.82 for patients with advanced liver fibrosis and 0.80 for those with cirrhosis. These results were reproduced in a validation study with no significant difference.
While liver biopsy is invasive, expensive and, in some settings, impossible to do, Fibro-α score is simple, cheap, non-invasive and may be useful for predicting significant liver fibrosis.
在埃及丙型肝炎病毒（HCV）感染较为常见的情况下，用于评估肝纤维化的非侵入性方法具有重要的临床意义。我们的目的是评估一组用于慢性丙型肝炎（CHC）患者肝纤维化的简单血液标志物的诊断性能。
共纳入199例接受抗病毒治疗资格评估的CHC患者。检测了包括转氨酶、胆红素、碱性磷酸酶、血清白蛋白、全血细胞计数、凝血酶原时间和甲胎蛋白（AFP）在内的肝脏生化指标。进行了肝活检。通过逻辑回归和受试者工作特征（ROC）曲线进行统计分析，以评估和比较血液标志物的诊断准确性。开发了一种逐步组合算法，并在另外135例患者中进行了前瞻性验证。
在检测的其他标志物中，甲胎蛋白（AFP）是最有效的标志物。对于显著肝纤维化（F2 - F4），AFP的曲线下面积（AUC）为0.77；对于晚期肝纤维化（F3 - F4），AUC为0.75；对于肝硬化（F4），AUC为0.76。逐步多变量判别分析（MDA）选择了一种用于鉴别显著肝纤维化患者的新型非侵入性指标，称为Fibro-α评分。Fibro-α评分 =（1.35（数值常数）+ AFP（IUml⁻¹）×0.009584 + 天冬氨酸转氨酶（AST）/丙氨酸转氨酶（ALT）×0.243 - 血小板计数（×10⁹l⁻¹）×0.001624）。Fibro-α评分用于晚期肝纤维化和肝硬化患者。对于晚期肝纤维化患者，Fibro-α评分的AUC为0.82，对于肝硬化患者为0.80。这些结果在验证研究中得到重现，无显著差异。
虽然肝活检具有侵入性、费用高且在某些情况下无法进行，但Fibro-α评分简单、便宜、非侵入性，可能有助于预测显著肝纤维化。
