Raftopoulos S C, George J, Bourliere M, Rossi E, de Boer W B, Jeffrey G P, Bulsara M, Speers D J, MacQuillan G, Ching H L I, Kontorinis N, Cheng W, Flexman J, Fermoyle S, Rigby P, Walsh L, McLeod D, Adams L A
Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia.
Storr Liver Unit, Westmead Millenium Institute, Westmead Hospital, University of Sydney, Sydney, Australia.
Hepatol Int. 2012 Apr;6(2):457-67. doi: 10.1007/s12072-011-9296-5. Epub 2011 Jul 12.
Liver fibrosis influences treatment and surveillance strategies in chronic hepatitis B (CHB). This multicenter study aimed to examine the accuracy of serum fibrosis models in CHB patients including those with low alanine aminotransferase (ALT) levels and serially in those undergoing treatment.
We examined noninvasive fibrosis models [Hepascore, Fibrotest, APRI, hepatitis e antigen (HBeAg)-positive and -negative models] in 179 CHB patients who underwent liver biopsy and fibrosis assessment by METAVIR and image morphometry. Serial Hepascore measurements were assessed in 40 subjects for up to 8.7 years.
Hepascore was more accurate than Fibrotest [area under the curve (AUC) 0.83 vs. 0.72, P = 0.05] and HBeAg-positive model (AUC 0.83 vs. 72, P = 0.03) for significant fibrosis but was not significantly different to APRI or HBeAg-negative scores. Fibrosis area assessed by morphometry was correlated with Hepascore (r = 0.603, P < 0.001), Fibrotest (r = 0.392, P = 0.03), and HBeAg-positive (r = 0.492, P = 0.001) scores only. Among 73 patients with an ALT <60 IU/L, noninvasive models were useful to predict fibrosis (PPV 80-90%) or exclude significant fibrosis (NPV 79-100%). Hepascore increased significantly among patients monitored without treatment and reduced among patients undergoing therapy (0.05/year ± 0.03 vs. -0.04/year ± 0.02, P = 0.007).
Serum fibrosis models are predictive of fibrosis in CHB and assist in identifying subjects with low-normal ALT levels for treatment.
肝纤维化影响慢性乙型肝炎（CHB）的治疗及监测策略。这项多中心研究旨在检验血清纤维化模型在CHB患者中的准确性，包括丙氨酸氨基转移酶（ALT）水平较低的患者以及接受治疗患者的连续情况。
我们对179例接受肝脏活检并通过METAVIR和图像形态计量学进行纤维化评估的CHB患者，检测了非侵入性纤维化模型[肝纤维化评分（Hepascore）、纤维检测（Fibrotest）、天冬氨酸氨基转移酶与血小板比值指数（APRI）、e抗原（HBeAg）阳性和阴性模型]。对40名受试者进行了长达8.7年的连续Hepascore测量。
对于显著纤维化，Hepascore比Fibrotest（曲线下面积[AUC]分别为0.83对0.72，P = 0.05）和HBeAg阳性模型（AUC 0.83对0.72，P = 0.03）更准确，但与APRI或HBeAg阴性评分无显著差异。通过形态计量学评估的纤维化面积仅与Hepascore（r = 0.603，P < 0.001）、Fibrotest（r = 0.392，P = 0.03）和HBeAg阳性（r = 0.492，P = 0.001）评分相关。在73例ALT<60 IU/L的患者中，非侵入性模型有助于预测纤维化（阳性预测值80 - 90%）或排除显著纤维化（阴性预测值79 - 100%）。未接受治疗的监测患者中Hepascore显著升高，接受治疗的患者中则降低（分别为每年0.05±0.03对每年 - 0.04±0.02，P = 0.007）。
血清纤维化模型可预测CHB患者的纤维化情况，并有助于识别ALT水平略低于正常的患者以进行治疗。
