de Oliveira Ana Cláudia, El-Bacha Ibrahin, Vianna Mônica V, Parise Edison R
Department of Medicine, Federal University of São Carlos (UFSCar), Brazil; Gastroenterology Division, Department of Internal Medicine, Federal University of São Paulo (UNIFESP), Brazil.
Gastroenterology Division, Department of Internal Medicine, Federal University of São Paulo (UNIFESP), Brazil.
Ann Hepatol. 2016 May-Jun;15(3):326-32. doi: 10.5604/16652681.1198801.
Chronic hepatitis C(CHC) staging is important for therapeutic decision-making. Identification of noninvasive markers can provide alternatives to liver biopsy.
To assess the value of APRI and FIB4 for CHC fibrosis staging in a cohort of nonselected outpatients from a referral center in Sao Paulo, Brazil.
Medical records of 798 adult outpatients were analyzed retrospectively. For calculations of APRI and FIB4, the original descriptions were considered, and markers were compared with degree of liver injury.
Overall, 49.3% of participants were female, and mean age was 56.9 ± 12.5 years. Genotype 1 was predominant (71.7 vs. 23.7% genotype 3); 64% had significant fibrosis, 44% had advanced fibrosis, and 28% had cirrhosis. The areas under the receiver operating curve for significant fibrosis, advanced fibrosis, and cirrhosis, respectively, were 0.809, 0.819, and 0.815 for the APRI marker and 0.803, 0.836 and 0.852 for FIB4. Using the recommended cut off values, approximately 30-40% of the patients could not be classified. In the remainder, either APRI or FIB4 alone correctly diagnosed 80-85% of cases. Concomitant or consecutive use of both APRI and FIB4 increased the number of the cases correctly diagnosed only slightly, but also increased the number of patients not classified within the cutoff values.
In conclusion, use of the APRI or FIB4 markers for detection of hepatic fibrosis may be a viable alternative at referral centers for treatment of CHC in low- and middle-income countries. Despite relatively good accuracy, a significant number of patients could not be assessed by these methods.
慢性丙型肝炎（CHC）分期对于治疗决策很重要。识别非侵入性标志物可为肝活检提供替代方法。
评估APRI和FIB4在巴西圣保罗一家转诊中心的非选择性门诊患者队列中对CHC纤维化分期的价值。
回顾性分析798例成年门诊患者的病历。计算APRI和FIB4时，采用原始描述，并将标志物与肝损伤程度进行比较。
总体而言，49.3%的参与者为女性，平均年龄为56.9±12.5岁。基因型1占主导（基因型3占71.7%对23.7%）；64%有显著纤维化，44%有进展性纤维化，28%有肝硬化。APRI标志物对于显著纤维化、进展性纤维化和肝硬化的受试者工作特征曲线下面积分别为0.809、0.819和0.815，FIB4分别为0.803、0.836和0.852。使用推荐的临界值，约30 - 40%的患者无法分类。其余患者中，单独使用APRI或FIB4可正确诊断80 - 85%的病例。同时或连续使用APRI和FIB4仅略微增加了正确诊断的病例数，但也增加了不在临界值范围内分类的患者数量。
总之，在低收入和中等收入国家的转诊中心，使用APRI或FIB4标志物检测肝纤维化可能是治疗CHC的一种可行替代方法。尽管准确性相对较好，但这些方法仍无法评估相当数量的患者。
