Karoui Sami, Ben Romdhane Sawssen, Serghini Meriem, Ben Mustapha Nadia, Boubaker Jalel, Haouet Slim, Filali Azza
Service de Gastro-enterologie A, Universite Tunis, El Manar.
Tunis Med. 2012 Apr;90(4):282-5.
Therapeutic indications in chronic genotype 1 hepatitis C are based on severity of fibrosis. APRI score is a simple, cheap and reproducible biochemical test. Performances of APRI score in Tunisian population with chronic hepatitis C were not previously prospectively studied.
To evaluate the performances of APRI score in prediction of severity of fibrosis in chronic genotype 1 hepatitis C based on a prospective study.
We prospectively include patients with chronic genotype 1 hepatitis C and positive viral load. Hepatic biopsy was performed in all included patients and abnormalities were classified according to METAVIR classification. In all patients, APRI score was calculated based on biochemical data collected within the 15 days before hepatic biopsy.
We studied 140 patients (46 men, mean age 48.4 years (20 - 65 years)). Mean APRI score was 0.89 (0.18 - 3.72). Statistically significant correlation was observed between APRI score and fibrosis severity (r = 0.31 p < 0.0001). APRI score was higher in patients with severe fibrosis (F2, F3 or F4) compared to patients with moderate fibrosis (F0 or F1) (0.97 + 0.68 vs 0.62 + 0.44; p 0.009). Threshold value of APRI score of 0.72 was associated with area under the curve of 0.65 + 0.05 (0.57 - 0.73), sensitivity of 56.3% and specificity of 75.8% in prediction of severe fibrosis. APRI score was also higher in patients with cirrhosis (1.24 + 0.79 vs 0.85 + 0.61; p = 0.01). Threshold value of 0.86 was associated with area under the curve of 0.69 + 0.07 (0.61 - 0.77), sensitivity of 76.4% and specificity of 65.8% in prediction of cirrhosis.
APRI score is not a good alternative to hepatic biopsy although a strong correlation with fibrosis severity, because of relatively low area under the curve, sensitivity and specificity in prediction of severe fibrosis and cirrhosis.
慢性基因1型丙型肝炎的治疗指征基于纤维化的严重程度。APRI评分是一种简单、廉价且可重复的生化检测方法。此前尚未对突尼斯慢性丙型肝炎患者群体中APRI评分的表现进行前瞻性研究。
基于一项前瞻性研究，评估APRI评分在预测慢性基因1型丙型肝炎纤维化严重程度方面的表现。
我们前瞻性纳入了慢性基因1型丙型肝炎且病毒载量呈阳性的患者。对所有纳入患者进行肝活检，并根据METAVIR分类对异常情况进行分类。在所有患者中，根据肝活检前15天内收集的生化数据计算APRI评分。
我们研究了140例患者（46名男性，平均年龄48.4岁（20 - 65岁））。平均APRI评分为0.89（0.18 - 3.72）。观察到APRI评分与纤维化严重程度之间存在统计学显著相关性（r = 0.31，p < 0.0001）。与中度纤维化（F0或F1）患者相比，重度纤维化（F2、F3或F4）患者的APRI评分更高（0.97 + 0.68对0.62 + 0.44；p 0.009）。APRI评分阈值为0.72时，预测重度纤维化的曲线下面积为0.65 + 0.05（0.57 - 0.73），敏感性为56.3%，特异性为75.8%。肝硬化患者的APRI评分也更高（1.24 + 0.79对0.85 + 0.61；p = 0.01）。阈值为0.86时，预测肝硬化的曲线下面积为0.69 + 0.07（0.61 - 0.77），敏感性为76.4%，特异性为65.8%。
尽管APRI评分与纤维化严重程度有很强的相关性，但由于其在预测重度纤维化和肝硬化时曲线下面积、敏感性和特异性相对较低，因此不是肝活检的良好替代方法。
