前瞻性评估 FibroTest®、FibroMeter® 和 HepaScore®在慢性乙型肝炎肝纤维化分期中的应用：与丙型肝炎的比较。
Prospective evaluation of FibroTest®, FibroMeter®, and HepaScore® for staging liver fibrosis in chronic hepatitis B: comparison with hepatitis C.
机构信息
Clinique Universitaire d'Hépato-Gastroentérologie, Pôle DIGIDUNE, CHU de Grenoble, France; Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France.
Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France; Département d'Anatomie et cytologie Pathologiques, Pôle de Biologie, CHU de Grenoble, France.
出版信息
J Hepatol. 2014 Jul;61(1):28-34. doi: 10.1016/j.jhep.2014.02.029. Epub 2014 Mar 11.
BACKGROUND & AIMS: Fibrosis blood tests have been validated in chronic hepatitis C. Their diagnostic accuracy is less documented in hepatitis B. The aim of this study was to describe the diagnostic performance of FibroTest®, FibroMeter®, and HepaScore® for liver fibrosis in hepatitis B compared to hepatitis C.
METHODS
510 patients mono-infected with hepatitis B or C and matched on fibrosis stage were included. Blood tests were performed the day of the liver biopsy. Histological lesions were staged according to METAVIR.
RESULTS
Fibrosis stages were distributed as followed: F0 n=76, F1 n=192, F2 n=132, F3 n=54, F4 n=56. Overall diagnostic performance of blood tests were similar between hepatitis B and C with AUROC ranging from 0.75 to 0.84 for significant fibrosis, 0.82 to 0.85 for extensive fibrosis and 0.84 to 0.87 for cirrhosis. Optimal cut-offs were consistently lower in hepatitis B compared to hepatitis C, especially for the diagnosis of extensive fibrosis and cirrhosis, with decreased sensitivity and negative predictive values. More hepatitis B than C patients with F ⩾3 were underestimated: FibroTest®: 47% vs. 26%, FibroMeter®: 24% vs. 6%, HepaScore®: 41% vs. 24%, p<0.01. Multivariate analysis showed that hepatitis B (0R 3.4, 95% CI 1.2-19.2, p<0.02) and low γGT (OR 7.3, 95% CI 2.0-27.0, p<0.003) were associated with fibrosis underestimation.
CONCLUSION
Overall the diagnostic performance of blood tests is similar in hepatitis B and C. The risk of underestimating significant fibrosis and cirrhosis is however greater in hepatitis B and cannot be entirely corrected by the use of more stringent cut-offs.
背景与目的
纤维化血液检测已在慢性丙型肝炎中得到验证。其在乙型肝炎中的诊断准确性记录较少。本研究的目的是描述 FibroTest®、FibroMeter®和 HepaScore®在乙型肝炎中诊断肝纤维化的性能，与丙型肝炎相比。
方法
纳入 510 例乙型或丙型肝炎单感染患者，并按纤维化分期进行匹配。血液检测在肝活检当天进行。组织学病变根据 METAVIR 分期。
结果
纤维化分期分布如下：F0 期 76 例，F1 期 192 例，F2 期 132 例，F3 期 54 例，F4 期 56 例。乙型肝炎和丙型肝炎的血液检测总体诊断性能相似，AUROC 范围从 0.75 到 0.84 用于显著纤维化，0.82 到 0.85 用于广泛纤维化，0.84 到 0.87 用于肝硬化。与丙型肝炎相比，乙型肝炎的最佳截断值始终较低，尤其是在广泛纤维化和肝硬化的诊断中，敏感性和阴性预测值降低。乙型肝炎比丙型肝炎有更多的 F ⩾3 患者被低估：FibroTest®：47%比 26%，FibroMeter®：24%比 6%，HepaScore®：41%比 24%，p<0.01。多变量分析显示，乙型肝炎（OR 3.4，95%CI 1.2-19.2，p<0.02）和低 γGT（OR 7.3，95%CI 2.0-27.0，p<0.003）与纤维化低估相关。
结论
总体而言，乙型肝炎和丙型肝炎的血液检测诊断性能相似。然而，乙型肝炎低估显著纤维化和肝硬化的风险更大，并且不能通过使用更严格的截断值完全纠正。
Zotero 插件