Wang Hong, Yan Rong, Zhou Yin, Wang Ming-Shan, Ruo Guo-Qin, Cheng Mei-Juan
Departments of *Infectious Diseases †Pathology, Zhejiang People's Provincial Hospital, Zhejiang, China.
J Clin Gastroenterol. 2015 Jan;49(1):69-75. doi: 10.1097/MCG.0000000000000090.
BACKGROUND/AIM: We aimed to develop a clinically useful scoring system to predict the probability of significant fibrosis (the Scheuer score ≥S2) in patients with chronic hepatitis B infection (CHB) and alanine aminotransferase (ALT) levels 2-fold lower than the upper limit of normal (ULN), in order to facilitate the clinical decision to perform a subsequent liver biopsy.
Consecutive subjects who underwent percutaneous liver biopsy were examined. The predictors evaluated included demographic, clinical, and laboratory variables. A clinical scoring system was developed by rounding the estimated regression coefficients for the independent predictors in multivariate logistic models for the diagnosis of significant fibrosis.
A total of 283 patients with ALT levels 2-fold lower than the ULN were divided into 2 groups to develop (n=190) and validate (n=93) the scoring system. Of the 190 subjects examined, 52 (27.4%) had significant fibrosis. Aspartate transferase levels, platelet counts, and hepatitis B surface antigen levels were independently associated with significant liver fibrosis. A fibrosis clinical scoring system comprising these 3 variables in CHB patients with ALT levels 2-fold lower than the ULN was developed to predict the probability of significant fibrosis in 4 categories (low, intermediate, high, and very high risk).
The proposed fibrosis scoring system predicted the probability of significant fibrosis in CHB patients with ALT levels 2-fold lower than the ULN with sufficient accuracy. It identified individuals with a very high risk for significant fibrosis in whom liver biopsy would most likely yield a diagnostic benefit. It also identified individuals with a low risk of moderate fibrosis in whom a liver biopsy can be delayed or avoided.
背景/目的：我们旨在开发一种临床实用的评分系统，以预测慢性乙型肝炎感染（CHB）且丙氨酸氨基转移酶（ALT）水平低于正常上限（ULN）两倍的患者发生显著纤维化（Scheuer评分≥S2）的概率，以便于做出后续进行肝活检的临床决策。
对接受经皮肝活检的连续受试者进行检查。评估的预测因素包括人口统计学、临床和实验室变量。通过对多变量逻辑模型中用于诊断显著纤维化的独立预测因素的估计回归系数进行四舍五入，开发了一种临床评分系统。
共有283例ALT水平低于ULN两倍的患者被分为两组，一组用于开发评分系统（n = 190），另一组用于验证（n = 93）。在接受检查的190名受试者中，52例（27.4%）有显著纤维化。天冬氨酸转氨酶水平、血小板计数和乙肝表面抗原水平与显著肝纤维化独立相关。开发了一种由这3个变量组成的纤维化临床评分系统，用于预测ALT水平低于ULN两倍的CHB患者发生显著纤维化的概率，分为4个类别（低、中、高和极高风险）。
所提出的纤维化评分系统能够以足够的准确性预测ALT水平低于ULN两倍的CHB患者发生显著纤维化的概率。它识别出显著纤维化风险极高的个体，对这些个体进行肝活检最有可能获得诊断益处。它还识别出中度纤维化风险低的个体，对这些个体可以延迟或避免进行肝活检。
