Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino, Tokyo, 180-8610, Japan.
J Gastroenterol. 2014 Nov;49(11):1495-503. doi: 10.1007/s00535-013-0914-y. Epub 2013 Dec 15.
The FIB-4 index is a simple formula to predict liver fibrosis. This study aimed to evaluate the utility of the FIB-4 index and associated time-course changes as a predictor of hepatocellular carcinoma (HCC) development.
A total of 171 chronic hepatitis C patients who underwent paired liver biopsies and 875 patients who underwent a single liver biopsy (validation group) were investigated during mean follow-up periods of 6.4 and 5.9 years, respectively. All patients had received interferon therapy and had not achieved a sustained virological response. Factors associated with HCC development were analyzed in these patients.
HCC developed in 30 patients in the paired biopsy group and 89 patients in the validation group. Univariate analysis demonstrated that the FIB-4 index >3.25 and change in the FIB-4 index per year (ΔFIB-4/year) ≥ 0.3 were predictive factors for HCC development in both groups. Multivariate analysis in the combined population revealed that these two factors were independent. The hazard ratio (HR) for the FIB-4 index >3.25 was 2.7 (p < 0.001) and ΔFIB-4/year ≥ 0.3 was 1.8 (p = 0.003). Patients with a FIB-4 index >3.25 and a ΔFIB-4/year ≥ 0.3 were defined as high risk, and those with a FIB-4 index ≤ 3.25 and a ΔFIB-4/year <0.3 were defined as low risk. The HR of HCC development in patients at high risk was 7.3 (95% confidence interval 4.3-12.5, p < 0.001).
It was possible to define a group at high risk of developing HCC by intermittently measuring the FIB-4 index and considering time-course changes in this index.
FIB-4 指数是一种预测肝纤维化的简单公式。本研究旨在评估 FIB-4 指数及其相关时间变化作为预测肝细胞癌 (HCC) 发展的指标的效用。
共对 171 例接受了配对肝活检的慢性丙型肝炎患者和 875 例接受了单次肝活检的患者（验证组）进行了研究，中位随访时间分别为 6.4 年和 5.9 年。所有患者均接受过干扰素治疗且未获得持续病毒学应答。分析了这些患者中与 HCC 发展相关的因素。
在配对活检组中，30 例患者发生 HCC，在验证组中 89 例患者发生 HCC。单因素分析表明，FIB-4 指数>3.25 和 FIB-4 指数每年变化（ΔFIB-4/年）≥0.3 是两组患者 HCC 发展的预测因素。联合人群的多因素分析显示，这两个因素是独立的。FIB-4 指数>3.25 的危险比（HR）为 2.7（p<0.001），ΔFIB-4/年≥0.3 的 HR 为 1.8（p=0.003）。FIB-4 指数>3.25 和 ΔFIB-4/年≥0.3 的患者定义为高危，FIB-4 指数≤3.25 和 ΔFIB-4/年<0.3 的患者定义为低危。高危患者 HCC 发展的 HR 为 7.3（95%置信区间 4.3-12.5，p<0.001）。
通过间歇性测量 FIB-4 指数并考虑该指数的时间变化，可以定义一组 HCC 发展风险较高的患者。
