Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany.
J Hepatol. 2013 Aug;59(2):236-42. doi: 10.1016/j.jhep.2013.03.016. Epub 2013 Mar 21.
BACKGROUND & AIMS: Progressive fibrosis is a major cause of morbidity and mortality in chronic liver disease. To replace liver biopsy for disease staging, multiple serum markers are under evaluation with multiparametric panels yielding the most promising results. The Enhanced Liver Fibrosis (ELF) score is an ECM marker set consisting of tissue inhibitor of metalloproteinases 1 (TIMP-1), amino-terminal propeptide of type III procollagen (PIIINP) and hyaluronic acid (HA) showing good correlations with fibrosis stages in chronic liver disease.
The ELF score was measured in 400 healthy controls and 79 chronic hepatitis C patients using an ADVIA Centaur automated system. The ELF score was calculated using the published algorithm combining TIMP-1, PIIINP and HA values. Patients' fibrosis stage was defined histologically. ROC analyses were performed to study marker validity. Reference values and influence factors for the ELF score were validated.
ELF score reference values ranged from 6.7 to 9.8 and were significantly higher for men vs. women (7.0-9.9 vs. 6.6-9.3, respectively). Afternoon values were slightly higher than morning values (6.7-9.9 vs. 6.6-9.5, respectively). Age was a notable influence factor. We identified three cut-off values: 7.7 for a high sensitivity exclusion of fibrosis, 9.8 for a high specificity identification of fibrosis (sensitivity 69%, specificity 98% for moderate fibrosis), and 11.3 to discriminate cirrhosis (sensitivity 83%, specificity 97%). ELF score validity was superior to the results of the single tests.
The ELF score can predict moderate fibrosis and cirrhosis. However, influence factors such as gender and age need to be taken into account.
进行性纤维化是慢性肝病患者发病率和死亡率的主要原因。为了替代肝活检进行疾病分期，正在评估多种血清标志物，其中多参数组合检测结果最有前途。增强型肝纤维化（ELF）评分是一种 ECM 标志物集，由基质金属蛋白酶组织抑制剂 1（TIMP-1）、III 型前胶原氨基末端前肽（PIIINP）和透明质酸（HA）组成，与慢性肝病的纤维化分期有很好的相关性。
使用 ADVIA Centaur 自动化系统在 400 名健康对照者和 79 名慢性丙型肝炎患者中测量 ELF 评分。ELF 评分使用发表的算法计算，该算法结合了 TIMP-1、PIIINP 和 HA 值。根据组织学定义患者的纤维化分期。进行 ROC 分析以研究标志物的有效性。验证了 ELF 评分的参考值和影响因素。
ELF 评分参考值范围为 6.7 至 9.8，男性明显高于女性（分别为 7.0-9.9 比 6.6-9.3）。下午的数值略高于上午（分别为 6.7-9.9 比 6.6-9.5）。年龄是一个显著的影响因素。我们确定了三个临界值：7.7 可高度敏感排除纤维化，9.8 可高度特异识别纤维化（中度纤维化的敏感性为 69%，特异性为 98%），11.3 可区分肝硬化（敏感性为 83%，特异性为 97%）。ELF 评分的有效性优于单项检测结果。
ELF 评分可预测中度纤维化和肝硬化。但是，需要考虑性别和年龄等影响因素。
