Li Q, Li W, Huang Y, Chen L
Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
J Viral Hepat. 2016 Nov;23(11):912-919. doi: 10.1111/jvh.12563. Epub 2016 Jul 4.
The gamma-glutamyl transpeptidase-to-platelet ratio (GPR) is a new serum diagnostic model, which is reported to be more accurate than aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for the diagnosis of significant fibrosis and cirrhosis in chronic HBV infection (CHBVI) patients in West Africa. To evaluate the performance of the GPR model for the diagnosis of liver fibrosis and cirrhosis in HBeAg-positive CHBVI patients with high HBV DNA (≥5 log copies/mL) and normal or mildly elevated alanine transaminase (ALT) (≤2 times upper limit of normal (ULN)) in China. A total of 1521 consecutive CHBVI patients who underwent liver biopsies and routine laboratory tests were retrospectively screened. Of these patients, 401 treatment naïve HBeAg-positive patients with HBV DNA≥5 log copies/mL and ALT≤2 ULN were included. The METAVIR scoring system was adopted as the pathological diagnosis standard of liver fibrosis. Using liver histology as a gold standard, the performances of GPR, APRI, and Fib-4 for the diagnosis of liver fibrosis and cirrhosis were evaluated and compared by receiver operating characteristic (ROC) curves and the area under the ROC curves (AUROCs). Of 401 patients, 121 (30.2%), 49 (12.2%) and 17 (4.2%) were classified as having significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4), respectively. After estimating the AUROC to predict significant fibrosis, the performance of GPR (AUROC=0.66, 95% CI 0.60-0.72) was higher than APRI (AUROC=0.58, 95% CI 0.52-0.64, P=.002) and Fib-4 scores (AUROC=0.54, 95% CI 0.47-0.60, P<.001). After estimating the AUROC to predict severe fibrosis, the performance of GPR (AUROC=0.71, 95% CI 0.63-0.80) was also higher than APRI (AUROC=0.65, 95% CI 0.56-0.73, P=.003) and Fib-4 scores (AUROC=0.67, 95% CI 0.58-0.75, P=.001). After estimating the AUROC to predict cirrhosis, the performance of GPR (AUROC=0.73, 95% CI 0.56-0.88) was higher than APRI (AUROC=0.69, 95% CI 0.54-0.83, P=.041) and Fib-4 scores (AUROC=0.69, 95% CI 0.55-0.82, P=.012) too. The GPR is a new serum model for the diagnosis of liver fibrosis and cirrhosis and shows obvious advantages in Chinese HBeAg-positive patients with HBV DNA≥5 log copies/mL and ALT≤2 ULN compared with APRI and Fib-4, thus warranting its widespread use for this specific population.
γ-谷氨酰转肽酶与血小板比值（GPR）是一种新的血清诊断模型，据报道，在诊断西非慢性乙型肝炎病毒感染（CHBVI）患者的显著纤维化和肝硬化方面，它比天冬氨酸转氨酶与血小板比值指数（APRI）和基于四项因子的纤维化指数（Fib-4）更准确。为了评估GPR模型在中国乙肝e抗原阳性、高乙肝病毒DNA（≥5 log拷贝/mL）且丙氨酸转氨酶（ALT）正常或轻度升高（≤正常上限（ULN）的2倍）的CHBVI患者中诊断肝纤维化和肝硬化的性能。对1521例连续接受肝活检和常规实验室检查的CHBVI患者进行回顾性筛查。其中，纳入401例未经治疗的乙肝e抗原阳性患者，其乙肝病毒DNA≥5 log拷贝/mL且ALT≤2 ULN。采用METAVIR评分系统作为肝纤维化的病理诊断标准。以肝脏组织学为金标准，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诊断肝纤维化和肝硬化的性能。401例患者中，分别有121例（30.2%）、49例（12.2%）和17例（4.2%）被分类为有显著纤维化（≥F2）、严重纤维化（≥F3）和肝硬化（=F4）。在估计预测显著纤维化的AUROC后，GPR的性能（AUROC=0.66，95%可信区间0.60-0.72）高于APRI（AUROC=0.58，95%可信区间0.52-0.64，P=0.002）和Fib-4评分（AUROC=0.54，95%可信区间0.47-0.60，P<0.001）。在估计预测严重纤维化的AUROC后，GPR的性能（AUROC=0.71，95%可信区间0.63-0.80）也高于APRI（AUROC=0.65，95%可信区间0.56-0.73，P=0.003）和Fib-4评分（AUROC=0.67，95%可信区间0.58-0.75，P=0.001）。在估计预测肝硬化的AUROC后，GPR的性能（AUROC=0.73，95%可信区间0.56-0.88）同样高于APRI（AUROC=0.69，95%可信区间0.54-0.83，P=0.041）和Fib-4评分（AUROC=0.69，95%可信区间0.55-0.82，P=0.012）。GPR是一种诊断肝纤维化和肝硬化的新型血清模型，在中国乙肝e抗原阳性、乙肝病毒DNA≥5 log拷贝/mL且ALT≤2 ULN的患者中，与APRI和Fib-4相比显示出明显优势，因此值得在这一特定人群中广泛应用。
