Li Qiang, Song Jie, Huang Yuxian, Li Xinyan, Zhuo Qibin, Li Weixia, Chen Chong, Lu Chuan, Qi Xun, Chen Liang
From the Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Medicine (Baltimore). 2016 Apr;95(16):e3372. doi: 10.1097/MD.0000000000003372.
The gamma-glutamyl-transpeptidase to platelet ratio (GPR) is a new liver fibrosis model, which is reported to be more accurate than aspartate transaminase (AST) to platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for diagnosing significant fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) in West Africa. The aim of this study is to assess the diagnostic accuracy of GPR for significant fibrosis and cirrhosis in Chinese CHB patients, and explore whether GPR deserves to be popularized in China. A total of 372 CHB patients who underwent liver biopsies and routine laboratory tests were retrospectively studied. The Scheuer scoring system was adopted as the pathological standard of liver fibrosis. Using liver histology as a gold standard, the diagnostic accuracies of GPR, APRI, and Fib-4 for significant fibrosis and cirrhosis are evaluated and compared by the receiver operating characteristic (ROC) curves and the area under the ROC curves (AUROCs). Of these 372 patients, 176 (47.3%), 129 (34.7%), and 72 (19.4%) were classified as having significant fibrosis (≥ S2), severe fibrosis (≥ S3), and cirrhosis (S4), respectively. The AUROCs of GPR for significant fibrosis (0.72 vs. 0.78; P = 0.01), severe fibrosis (0.75 vs. 0.80; P = 0.04), and cirrhosis (0.78 vs. 0.83; P = 0.02) were lower than those of APRI. The AUROCs of GPR and Fib-4 for diagnosing significant fibrosis (0.72 vs. 0.70; P = 0.29), severe fibrosis (0.75 vs. 0.73; P = 0.33), and cirrhosis (0.78 vs. 0.75; P = 0.38) were comparable. GPR is a new serum diagnostic model for liver fibrosis and cirrhosis, but does not show advantages than APRI and Fib-4 in identifying significant fibrosis, severe fibrosis, and cirrhosis in CHB patients in China.
γ-谷氨酰转肽酶与血小板比值（GPR）是一种新的肝纤维化模型，据报道，在诊断西非慢性乙型肝炎（CHB）患者的显著肝纤维化和肝硬化方面，它比天冬氨酸转氨酶（AST）与血小板比值指数（APRI）以及基于四项因子的纤维化指数（Fib-4）更为准确。本研究旨在评估GPR对中国CHB患者显著肝纤维化和肝硬化的诊断准确性，并探讨GPR在中国是否值得推广。对372例接受肝活检和常规实验室检查的CHB患者进行回顾性研究。采用Scheuer评分系统作为肝纤维化的病理标准。以肝组织学为金标准，通过受试者工作特征（ROC）曲线及ROC曲线下面积（AUROC）评估并比较GPR、APRI和Fib-4对显著肝纤维化和肝硬化的诊断准确性。在这372例患者中，分别有176例（47.3%）、129例（34.7%）和72例（19.4%）被分类为有显著肝纤维化（≥S2）、重度肝纤维化（≥S3）和肝硬化（S4）。GPR对显著肝纤维化（0.72对0.78；P = 0.01）、重度肝纤维化（0.75对0.80；P = 0.04）和肝硬化（0.78对0.83；P = 0.02）的AUROC低于APRI。GPR和Fib-4对诊断显著肝纤维化（0.72对0.70；P = 0.29）、重度肝纤维化（0.75对0.73；P = 0.33）和肝硬化（0.78对0.75；P = 0.38）的AUROC相当。GPR是一种新的肝纤维化和肝硬化血清诊断模型，但在中国CHB患者中识别显著肝纤维化、重度肝纤维化和肝硬化方面，并不比APRI和Fib-4具有优势。
