Rosso Chiara, Caviglia Gian Paolo, Abate Maria Lorena, Vanni Ester, Mezzabotta Lavinia, Touscoz Giovanni Antonio, Olivero Antonella, Marengo Andrea, Rizzetto Mario, Bugianesi Elisabetta, Smedile Antonina
Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy.
Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy.
Dig Liver Dis. 2016 Jan;48(1):55-61. doi: 10.1016/j.dld.2015.09.008. Epub 2015 Sep 28.
The combination of non-invasive markers for the detection of fibrosis in patients with chronic liver diseases is still a matter of debate.
To test the performance of cytokeratin18-Aspartate396 alone or in combination with transient elastography as a marker of fibrosis, compared to liver biopsy as gold standard.
In 259 prospectively enrolled patients with chronic liver diseases, clinical, biochemical, and histological features were assessed. Serum cytokeratin18-Aspartate396 and Fibroscan were performed within 6 months prior to liver biopsy.
Cytokeratin18-Aspartate396 levels predicted both significant and advanced fibrosis in non-alcoholic fatty liver disease group, correctly identifying 83.7% and 80.8% of cases, respectively. Liver stiffness performed best in predicting severe fibrosis in patients with chronic viral infection, correctly identifying 78.7% of chronic hepatitis B and 88.6% of chronic hepatitis C subjects. The combination of cytokeratin18-Aspartate396 and liver stiffness improved their diagnostic performance for the detection of significant and advanced fibrosis in non-alcoholic fatty liver disease group, only (sensitivity=78.3%, specificity=90.7%; sensitivity=91.7%, specificity=71.6%, respectively).
Cytokeratin18-Aspartate396 and liver stiffness can improve the non-invasive prediction of significant and advanced fibrosis in patients with non-alcoholic fatty liver disease, while in hepatitis B and C virus infected patients their combined use had no advantage over the diagnostic accuracy of transient elastography alone.
慢性肝病患者中用于检测纤维化的非侵入性标志物组合仍存在争议。
与作为金标准的肝活检相比，测试细胞角蛋白18-天冬氨酸396单独或与瞬时弹性成像联合作为纤维化标志物的性能。
在259例前瞻性纳入的慢性肝病患者中，评估临床、生化和组织学特征。在肝活检前6个月内检测血清细胞角蛋白18-天冬氨酸396和进行Fibroscan检查。
在非酒精性脂肪性肝病组中，细胞角蛋白18-天冬氨酸396水平可预测显著纤维化和重度纤维化，分别正确识别出83.7%和80.8%的病例。肝硬度值在预测慢性病毒感染患者的重度纤维化方面表现最佳，正确识别出78.7%的慢性乙型肝炎患者和88.6%的慢性丙型肝炎患者。仅在非酒精性脂肪性肝病组中，细胞角蛋白18-天冬氨酸396和肝硬度值的联合使用提高了其对显著纤维化和重度纤维化的诊断性能（敏感性分别为78.3%、特异性为90.7%；敏感性分别为91.7%、特异性为71.6%）。
细胞角蛋白18-天冬氨酸396和肝硬度值可改善非酒精性脂肪性肝病患者显著纤维化和重度纤维化的非侵入性预测，而在乙型和丙型肝炎病毒感染患者中，它们的联合使用相比单独使用瞬时弹性成像的诊断准确性并无优势。
