Division of Genetics and Molecular Medicine, St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, U.K.
Br J Dermatol. 2014 Aug;171(2):267-73. doi: 10.1111/bjd.12782. Epub 2014 Jun 18.
Methotrexate is a cost-effective systemic treatment for moderate-to-severe psoriasis, but the perceived risk of associated liver fibrosis prevents optimal use. Procollagen III aminoterminal propeptide (PIIINP) is a widely adopted noninvasive biomarker of liver fibrosis; however, its clinical utility is narrow owing to limited evidence of performance and the need for serial measurement. The Enhanced Liver Fibrosis (ELF) assay is a validated biomarker of liver fibrosis.
To evaluate the diagnostic accuracy of the ELF test compared with PIIINP for the diagnosis of liver fibrosis in a cohort of patients with psoriasis treated with methotrexate.
A retrospective cohort study comparing the diagnostic accuracy of PIIINP and ELF in detecting liver fibrosis in patients treated with methotrexate. Liver biopsy was the reference standard.
Twenty-seven patients were identified and included in the study. The diagnostic accuracies [area under the receiver operating curve (AUROC)] of serial PIIINP and serial ELF were 0·589 [95% confidence interval (CI) 0·379-0·800] and 0·643 (95% CI 0·391-0·895), respectively, for mild fibrosis; and 0·576 (95% CI 0·237-0·916) and 0·674 (95% CI 0·421-0·927) for at least moderate fibrosis. The AUROC values for single PIIINP and single ELF were 0·582 (95% CI 0·363-0·801) and 0·693 (95% CI 0·482-0·904), respectively, for mild fibrosis; and 0·667 (95% CI 0·363-0·971) and 0·806 (95% CI 0·564-1·000) for at least moderate fibrosis.
This pilot study suggests that ELF may be at least equivalent or possibly superior to PIIINP in the detection of liver fibrosis in patients with psoriasis treated with methotrexate, and supports further investigations into the performance of ELF in this clinical setting.
甲氨蝶呤是一种具有成本效益的中重度银屑病的系统性治疗药物，但由于担心相关肝纤维化的风险，其使用并不理想。III 型前胶原氨基末端肽（PIIINP）是一种广泛采用的肝纤维化无创生物标志物；然而，由于其性能和需要连续测量的证据有限，其临床应用受到限制。增强型肝脏纤维化（ELF）检测是一种经过验证的肝纤维化生物标志物。
评估 ELF 检测与 PIIINP 相比在诊断接受甲氨蝶呤治疗的银屑病患者肝纤维化中的诊断准确性。
一项回顾性队列研究比较了 PIIINP 和 ELF 在检测接受甲氨蝶呤治疗的患者肝纤维化中的诊断准确性。肝活检为参考标准。
确定了 27 名患者并纳入研究。连续 PIIINP 和连续 ELF 的诊断准确性[接受者操作特征曲线下面积（AUROC）]分别为轻度纤维化 0.589（95%置信区间 0.379-0.800）和 0.643（95%置信区间 0.391-0.895），至少中度纤维化为 0.576（95%置信区间 0.237-0.916）和 0.674（95%置信区间 0.421-0.927）。单次 PIIINP 和单次 ELF 的 AUROC 值分别为轻度纤维化 0.582（95%置信区间 0.363-0.801）和 0.693（95%置信区间 0.482-0.904），至少中度纤维化为 0.667（95%置信区间 0.363-0.971）和 0.806（95%置信区间 0.564-1.000）。
这项初步研究表明，ELF 可能至少与 PIIINP 一样或可能优于检测接受甲氨蝶呤治疗的银屑病患者的肝纤维化，支持进一步研究 ELF 在这种临床环境中的性能。
