Sheptulina Anna, Shirokova Elena, Nekrasova Tatiana, Blum Hubert, Ivashkin Vladimir
Department of Hepatology, V.H. Vasilenko Clinic of Internal Diseases, Gastroenterology and Hepatology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation.
Department of Pathology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation.
J Gastroenterol Hepatol. 2016 Dec;31(12):1956-1962. doi: 10.1111/jgh.13407.
Non-invasive markers are essential to assess the progression of chronic liver diseases to fibrosis/ cirrhosis and the effectiveness of therapeutic strategies. The aim of this study was to evaluate the ability of non-invasive markers to identify significant fibrosis, severe fibrosis, and cirrhosis in patients with autoimmune hepatitis (AIH).
Seventy-six patients with AIH were enrolled in the study and analyzed for the following parameters of liver fibrosis: Fibrosis 4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST to platelet count ratio (APRI), and platelet count to spleen diameter (PC/SD) ratio. All patients underwent liver biopsy. The diagnostic accuracy of tests was evaluated by the area under the receiver operating characteristic curve (AUROC).
Among the 76 AIH patients, 55 (72.3%) had significant fibrosis (≥ F2), 37 (48.7%) had severe fibrosis (≥ F3), and 29 (38.2%) had cirrhosis (F4). PC/SD ratio (AUROC = 0.840) was superior to AAR (AUROC = 0.756), FIB-4 (AUROC = 0.702), and APRI (AUROC = 0.626) in discriminating between mild and significant fibrosis (≥ F2). The AUROCs of PC/SD ratio, FIB-4, AAR, and APRI were 0.884, 0.742, 0.731, and 0.707, respectively, for severe fibrosis (≥ F3); 0.968, 0.795, 0.744, and 0.723, respectively, for cirrhosis (F4). PC/SD ratio correctly identified 85.1% of patients with severe fibrosis, and 89.6% of patients with cirrhosis.
PC/SD ratio proved to be a simple non-invasive tool to correctly identify AIH patients with severe fibrosis and cirrhosis, thereby reducing the need for a liver biopsy in these patients.
非侵入性标志物对于评估慢性肝病向纤维化/肝硬化的进展以及治疗策略的有效性至关重要。本研究旨在评估非侵入性标志物在自身免疫性肝炎（AIH）患者中识别显著纤维化、严重纤维化和肝硬化的能力。
76例AIH患者纳入本研究，并对以下肝纤维化参数进行分析：纤维化4评分（FIB-4）、天冬氨酸转氨酶（AST）与丙氨酸转氨酶（ALT）比值（AAR）、AST与血小板计数比值（APRI）以及血小板计数与脾脏直径（PC/SD）比值。所有患者均接受了肝活检。通过受试者操作特征曲线下面积（AUROC）评估检测的诊断准确性。
在76例AIH患者中，55例（72.3%）有显著纤维化（≥F2），37例（48.7%）有严重纤维化（≥F3），29例（38.2%）有肝硬化（F4）。在区分轻度和显著纤维化（≥F2）方面，PC/SD比值（AUROC = 0.840）优于AAR（AUROC = 0.756）、FIB-4（AUROC = 0.702）和APRI（AUROC = 0.626）。对于严重纤维化（≥F3），PC/SD比值、FIB-4、AAR和APRI的AUROC分别为0.884、0.742、0.731和0.707；对于肝硬化（F4），分别为0.968、0.795、0.744和0.723。PC/SD比值正确识别了85.1%的严重纤维化患者和89.6%的肝硬化患者。
PC/SD比值被证明是一种简单的非侵入性工具，能够正确识别患有严重纤维化和肝硬化的AIH患者，从而减少这些患者进行肝活检的必要性。
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