Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples Federico II, Naples, Italy.
J Hepatol. 2012 Apr;56(4):782-7. doi: 10.1016/j.jhep.2011.10.015. Epub 2011 Dec 13.
BACKGROUND & AIMS: Although numerous non-invasive tests are currently available to explore liver function and disease activity in patients with HCV-related chronic diseases, none of these indicate the likelihood of disease progression in the individual patient. We aimed at assessing the prognostic ability of (13)C(2)-aminopyrine breath test ((13)C-ABT) in the prediction of liver fibrosis progression in patients with HCV chronic hepatitis who prospectively entered a long-term follow-up.
Fifty patients with HCV-related chronic disease who underwent paired liver biopsy (at baseline and after a mean period of 86 months) were included in the study. (13)C-ABT was carried out at baseline and every 3 years. Histological progression was defined as increase of at least 2 fibrosis units according to Ishak score.
Fourteen patients progressed of at least 2 fibrosis units during the follow-up. These patients were more frequently infected with a HCV-1b genotype and had, at baseline, a significantly older age, higher BMI, AST levels, and AST to platelet ratio index (APRI). (13)C-ABT was altered in 57% of cases at baseline and in 100% of the cases at 3-year follow-up. In the univariate analysis, age (p=0.005), BMI (p=0.006), platelet count (p=0.03), AST (p=0.012) and ALT (p=0.04) levels, APRI (p=0.03), and baseline (13)C-ABT results (p<0.0001) were all independently associated with progression of liver fibrosis. By Cox's multiple regression analysis, the (13)C-ABT was the only covariate that significantly predicted liver fibrosis progression (HR 6.7; 95% CI 2.3-20.1; p<0.001).
(13)C-ABT accurately predicts the risk of disease progression in patients with HCV-related chronic hepatitis.
虽然目前有许多非侵入性检查可用于探索 HCV 相关慢性疾病患者的肝功能和疾病活动度，但没有一种检查能够表明个体患者疾病进展的可能性。我们旨在评估（13）C（2）-氨基比林呼气试验（（13）C-ABT）在预测 HCV 慢性肝炎患者疾病进展方面的预后能力，这些患者前瞻性地进入了长期随访。
本研究纳入了 50 例接受了配对肝活检（基线和平均 86 个月后）的 HCV 相关慢性疾病患者。（13）C-ABT 在基线时和每 3 年进行一次。组织学进展定义为根据 Ishak 评分增加至少 2 个纤维化单位。
在随访期间，14 例患者的纤维化程度至少增加了 2 个单位。这些患者更常感染 HCV-1b 基因型，且基线时年龄较大、BMI 较高、AST 水平和 AST 与血小板比值指数（APRI）较高。（13）C-ABT 在基线时改变了 57%的病例，在 3 年随访时改变了 100%的病例。在单因素分析中，年龄（p=0.005）、BMI（p=0.006）、血小板计数（p=0.03）、AST（p=0.012）和 ALT（p=0.04）水平、APRI（p=0.03）和基线（13）C-ABT 结果（p<0.0001）均与肝纤维化进展独立相关。通过 Cox 多因素回归分析，（13）C-ABT 是唯一显著预测肝纤维化进展的协变量（HR 6.7；95%CI 2.3-20.1；p<0.001）。
（13）C-ABT 能准确预测 HCV 相关慢性肝炎患者疾病进展的风险。
