Ucar Fatma, Sezer Sevilay, Ginis Zeynep, Ozturk Gulfer, Albayrak Aynur, Basar Omer, Ekiz Fuat, Coban Sahin, Yuksel Osman, Armutcu Ferah, Akbal Erdem
Departments of aClinical Biochemistry bPathology cGastroenterology, Diskapi Yildirim Beyazit Training and Research Hospital dDepartment of Clinical Biochemistry, Numune Training and Research Hospital eDepartment of Clinical Biochemistry, Faculty of Medicine, Fatih University fDepartment of Gastroenterology, Ankara Training and Research Hospital, Ankara, Turkey.
Eur J Gastroenterol Hepatol. 2013 Sep;25(9):1076-81. doi: 10.1097/MEG.0b013e32835fd699.
The aim of this study was to evaluate the potential use of serum transforming growth factor-β1 (TGF-β1), tissue inhibitor of metalloproteinase-1 (TIMP-1), fetuin-A, and fibroblast growth factor 21 (FGF21) in the detection of liver fibrosis in patients with chronic hepatitis B (CHB). The value of the noninvasive fibrosis models - that is, the aspartate aminotransferase to platelet ratio index (APRI), the fibrosis index based on the four factors (FIB-4) score, and Forn's index - was also examined.
CHB patients who underwent liver biopsy for the evaluation of fibrosis were included in the study. A total of 73 patients were divided into two groups according to their METAVIR scores (F0-1, no/minimal fibrosis; F2-4, significant fibrosis). Serum levels of TGF-β1, TIMP-1, fetuin-A, and FGF21 were measured besides APRI, FIB-4, and Forn's scores. The area under the receiver operating characteristic curve was measured for each parameter, followed by calculation of sensitivity, specificity, and positive and negative predictive values.
APRI, FIB-4, and Forn's index scores were significantly higher in patients with significant fibrosis (P<0.05). There was no difference between no/minimal fibrosis and significant fibrosis groups in terms of serum levels of TGFβ-1, TIMP-1, fetuin-A, and FGF21 (P>0.05). The areas under the receiver operating characteristic curve for TGF-β1, TIMP-1, fetuin-A, FGF21, APRI, FIB-4, and Forn's index were 0.445, 0.483, 0.436, 0.585, 0.662, 0.687, and 0.680, respectively.
Our results suggest that serum TGF-β1, TIMP-1, fetuin-A, and FGF21 are not useful for the assessment of the extent of liver fibrosis in CHB in this patient group. However, APRI, FIB-4, and Forn's index have a better diagnostic value in patients with significant fibrosis than in those with no/minimal fibrosis.
本研究旨在评估血清转化生长因子-β1（TGF-β1）、金属蛋白酶组织抑制剂-1（TIMP-1）、胎球蛋白-A和成纤维细胞生长因子21（FGF21）在慢性乙型肝炎（CHB）患者肝纤维化检测中的潜在应用价值。同时也检测了非侵入性纤维化模型，即天冬氨酸转氨酶与血小板比值指数（APRI）、基于四项因子的纤维化指数（FIB-4）评分及福尔恩指数的价值。
纳入因评估纤维化而行肝活检的CHB患者。根据METAVIR评分将73例患者分为两组（F0-1，无/轻度纤维化；F2-4，显著纤维化）。除检测APRI、FIB-4和福尔恩评分外，还测定血清TGF-β1、TIMP-1、胎球蛋白-A和FGF21水平。测量各参数的受试者操作特征曲线下面积，随后计算敏感性、特异性以及阳性和阴性预测值。
显著纤维化患者的APRI、FIB-4和福尔恩指数评分显著更高（P<0.05）。在无/轻度纤维化组和显著纤维化组之间，血清TGFβ-1、TIMP-1、胎球蛋白-A和FGF21水平无差异（P>0.05）。TGF-β1、TIMP-1、胎球蛋白-A、FGF21、APRI、FIB-4和福尔恩指数的受试者操作特征曲线下面积分别为0.445、0.483、0.436、0.585、0.662、0.687和0.680。
我们的结果表明，血清TGF-β1、TIMP-1、胎球蛋白-A和FGF21在该患者群体的CHB肝纤维化程度评估中并无作用。然而，APRI、FIB-4和福尔恩指数在显著纤维化患者中的诊断价值优于无/轻度纤维化患者。
