Yosry Ayman, Fouad Rabab, Alem Shereen A, Elsharkawy Aisha, El-Sayed Mohammad, Asem Noha, Hassan Ehsan, Ismail Ahmed, Esmat Gamal
Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Arab J Gastroenterol. 2016 Jun;17(2):78-83. doi: 10.1016/j.ajg.2016.05.002. Epub 2016 Jun 25.
Multiple noninvasive methods have been used successfully in the prediction of fibrosis. However, their role in the prediction of response to hepatitis C virus (HCV) antiviral therapy is debatable. The aim of this study was to validate and compare the diagnostic performance of FibroScan, APRI (aspartate aminotransferase (AST)-to-platelet ratio index), FIB4, and GUCI (Göteborg University Cirrhosis Index) for the prediction of hepatic fibrosis and treatment outcome in HCV-infected patients receiving pegylated interferon and ribavirin (PEG-IFN/ribavirin).
This study included 182 Egyptian patients with chronic HCV infection. They were classified into two groups based on the stages of fibrosis: mild to significant fibrosis (F1-F2) and advanced fibrosis (F3-F4). The APRI, FIB4, and GUCI scores were calculated before the antiviral treatment. The FibroScan was performed for all patients before treatment.
Stiffness and FIB4 have greater sensitivity and specificity in detecting advanced fibrosis of 80%, 77% and 88%, 84%, respectively. Based on multivariate regression analysis, FIB4, body mass index (BMI), and alpha-fetoprotein (AFP) level were found to be statistically significant predictors of advanced fibrosis (p-value: 0.000, 0.011, and 0.001, respectively) with odds ratio (OR: 3.184, 1.170, and 1.241, respectively). With respect to virological response, the stiffness, APRI, FIB4, and GUCI were significantly lower in sustained virological responders. However, these are not good predictors of response to PEG-IFN/ribavirin therapy. AFP was the only statistically significant predictor of response (p=0.002) with OR of 1.141 in multivariate regression analysis.
FibroScan and noninvasive scores such as APRI, FIB4, and GUCI can be used as good predictors of liver fibrosis in chronic hepatitis C. However, they are not good predictors of response to PEG-IFN/ribavirin therapy.
多种非侵入性方法已成功用于预测肝纤维化。然而，它们在预测丙型肝炎病毒（HCV）抗病毒治疗反应中的作用存在争议。本研究的目的是验证并比较FibroScan、APRI（天冬氨酸转氨酶（AST）与血小板比值指数）、FIB4和GUCI（哥德堡大学肝硬化指数）在预测接受聚乙二醇干扰素和利巴韦林（PEG-IFN/利巴韦林）治疗的HCV感染患者肝纤维化及治疗结果方面的诊断性能。
本研究纳入182例埃及慢性HCV感染患者。根据肝纤维化阶段将他们分为两组：轻度至显著纤维化（F1-F2）和重度纤维化（F3-F4）。在抗病毒治疗前计算APRI、FIB4和GUCI评分。所有患者在治疗前均进行FibroScan检查。
硬度值和FIB4在检测重度纤维化方面具有更高的敏感性和特异性，分别为80%、77%和88%、84%。基于多因素回归分析，发现FIB4、体重指数（BMI）和甲胎蛋白（AFP）水平是重度纤维化的统计学显著预测因素（p值分别为0.000、0.011和0.001），比值比（OR分别为3.184、1.170和1.241）。关于病毒学反应，持续病毒学应答者的硬度值、APRI、FIB4和GUCI显著更低。然而，这些并非PEG-IFN/利巴韦林治疗反应的良好预测指标。AFP是多因素回归分析中唯一具有统计学显著意义的反应预测指标（p=0.002），OR为1.141。
FibroScan以及APRI、FIB4和GUCI等非侵入性评分可作为慢性丙型肝炎肝纤维化的良好预测指标。然而，它们并非PEG-IFN/利巴韦林治疗反应的良好预测指标。
