Departments of aHepatogastroenterology bBiochemistry and Hormonology cPathology, AP-HP, Antoine-Béclère Hospital dINSERM, U996, IPSIT, Clamart eUniv Paris-South, Faculty of Medicine Paris-South, Le Kremlin-Bicêtre, France.
Eur J Gastroenterol Hepatol. 2014 Apr;26(4):404-11. doi: 10.1097/MEG.0000000000000041.
The PGAA index was one of the first composite liver fibrosis markers. This study aims, prospectively, to confirm the diagnostic value of PGAA and Fibrotest in patients with alcoholic liver disease and to compare their diagnostic performances.
We prospectively included 200 consecutive patients (159 men and 41 women; mean age: 51±0.7 years).The PGAA index was calculated by combining the results of four laboratory tests (prothrombin time, γ-glutamyl transpeptidase, apolipoprotein A1, and α-2-macroglobulin) scored on a 0-4 scale. The Fibrotest score was computed using the Biopredictive website. The overall diagnostic performances of scores were evaluated in terms of the area under the receiver operating characteristic (AUROC) curve. The Obuchowski measure was assessed taking into account the distribution of fibrosis stages observed in the cohort.
For predicting F≥2 fibrosis stage, the AUROC curves of PGAA and Fibrotest were 0.83±0.03 and 0.80±0.03, respectively. For predicting F4 fibrosis stage, the AUROC curves of PGAA and Fibrotest were 0.87±0.03 and 0.86±0.03. There was no difference between the AUROC curves of PGAA and Fibrotest. The Obuchowski measure was 0.92±0.01 for PGAA and Fibrotest. For a value of 10, PGAA had 98% specificity and 97% positive predictive value for the detection of F≥2 fibrosis stage and 80% sensitivity and 92% negative predictive value for F4 stage fibrosis.
We confirm the comparable diagnostic values of Fibrotest and PGAA. When Fibrotest use is constrained by an increase in unconjugated bilirubin or is not financially viable, PGAA may be an alternative.
PGAA 指数是最早的复合肝纤维化标志物之一。本研究旨在前瞻性地确认 PGAA 和 Fibrotest 在酒精性肝病患者中的诊断价值，并比较它们的诊断性能。
我们前瞻性纳入了 200 例连续患者（159 名男性和 41 名女性；平均年龄：51±0.7 岁）。PGAA 指数通过将四项实验室检测（凝血酶原时间、γ-谷氨酰转肽酶、载脂蛋白 A1 和α-2-巨球蛋白）的结果结合起来，以 0-4 分进行评分来计算。Fibrotest 评分使用 Biopredictive 网站计算。通过考虑队列中观察到的纤维化阶段分布，评估评分的总体诊断性能。
对于预测 F≥2 纤维化阶段，PGAA 和 Fibrotest 的 AUROC 曲线分别为 0.83±0.03 和 0.80±0.03。对于预测 F4 纤维化阶段，PGAA 和 Fibrotest 的 AUROC 曲线分别为 0.87±0.03 和 0.86±0.03。PGAA 和 Fibrotest 的 AUROC 曲线之间没有差异。PGAA 和 Fibrotest 的 Obuchowski 度量分别为 0.92±0.01。对于值为 10，PGAA 检测 F≥2 纤维化阶段的特异性为 98%，阳性预测值为 97%，F4 纤维化阶段的敏感性为 80%，阴性预测值为 92%。
我们确认了 Fibrotest 和 PGAA 的可比诊断价值。当 Fibrotest 的使用受到未结合胆红素的增加或经济上不可行的限制时，PGAA 可能是一种替代方法。
