National Hepatology and Tropical Medicine Research institute, Cairo, Egypt.
Department of Internal Medicine, Al-Azhar University, Cairo, Egypt.
J Med Virol. 2018 Jun;90(6):1080-1086. doi: 10.1002/jmv.25026. Epub 2018 Mar 12.
Serum levels of alpha-fetoprotein (AFP) were reported to increase in patients with significant or advanced hepatic fibrosis. Combination of non-invasive tests decreases the use of liver biopsy in large proportion of chronic HCV patients. The aim of the study was to compare and combine AFP with commonly used non-invasive fibrosis tests in novel scores for prediction of different stages of hepatic fibrosis. Six hundred and fifty two treatment naïve chronic hepatitis C patients were enrolled. Demographic data, basic pre-treatment laboratory tests including complete blood count (CBC), liver biochemical profile and renal functions test, international normalized ratio (INR) in addition to AFP, liver stiffness measurement (LSM) by Fibroscan and liver biopsies were retrospectively analyzed. AST to Platelet Ratio Index (APRI) and FIB-4 scores were calculated. Different predictive models using multivariate logistic regression analysis were generated and presented in equations (scores) composed of a combination of AFP, LSM plus FIB-4/APRI scores. AFP was correlating significantly with LSM, FIB-4, and APRI scores. Areas under receiver operating characteristic curves (AUROCs) for predicting significant hepatic fibrosis, advanced hepatic fibrosis, and cirrhosis were 0.897, 0.931, and 0.955, respectively, for equations (scores) containing AFP, LSM, and FIB-4. AUROCs for predicting significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis were 0.897, 0.929, and 0.959, respectively, for equations (scores) containing AFP, LSM, and APRI. The study shows that combining AFP to serum biomarkers and LSM increases their diagnostic performance for prediction of different stages of liver fibrosis.
血清甲胎蛋白（AFP）水平在有显著或晚期肝纤维化的患者中报告增加。非侵入性测试的组合在很大程度上减少了慢性 HCV 患者的肝活检使用。本研究的目的是比较 AFP 与常用的非侵入性纤维化测试，并在新型评分中结合用于预测不同阶段的肝纤维化。纳入了 652 例初治慢性丙型肝炎患者。回顾性分析了人口统计学数据、基本治疗前实验室检查，包括全血细胞计数（CBC）、肝功能生化谱和肾功能检查、国际标准化比值（INR），以及 AFP、Fibroscan 肝硬度测量（LSM）和肝活检。计算 AST 与血小板比值指数（APRI）和 FIB-4 评分。使用多元逻辑回归分析生成了不同的预测模型，并以包含 AFP、LSM 加 FIB-4/APRI 评分的组合方程（评分）表示。AFP 与 LSM、FIB-4 和 APRI 评分显著相关。包含 AFP、LSM 和 FIB-4 的方程（评分）预测显著肝纤维化、晚期肝纤维化和肝硬化的受试者工作特征曲线下面积（AUROCs）分别为 0.897、0.931 和 0.955。包含 AFP、LSM 和 APRI 的方程（评分）预测显著肝纤维化、晚期肝纤维化和肝硬化的 AUROCs 分别为 0.897、0.929 和 0.959。该研究表明，将 AFP 与血清生物标志物和 LSM 相结合可提高其对不同阶段肝纤维化的预测诊断性能。
