1 Department of Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University , Cairo, Egypt .
2 Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University , Cairo, Egypt .
Viral Immunol. 2018 May;31(4):315-320. doi: 10.1089/vim.2017.0134. Epub 2018 Apr 9.
Stage of liver fibrosis is critical for treatment decision and prediction of outcomes in chronic hepatitis C (CHC) patients. We evaluated the diagnostic accuracy of transient elastography (TE)-FibroScan and noninvasive serum markers tests in the assessment of liver fibrosis in CHC patients, in reference to liver biopsy. One-hundred treatment-naive CHC patients were subjected to liver biopsy, TE-FibroScan, and eight serum biomarkers tests; AST/ALT ratio (AAR), AST to platelet ratio index (APRI), age-platelet index (AP index), fibrosis quotient (FibroQ), fibrosis 4 index (FIB-4), cirrhosis discriminant score (CDS), King score, and Goteborg University Cirrhosis Index (GUCI). Receiver operating characteristic curves were constructed to compare the diagnostic accuracy of these noninvasive methods in predicting significant fibrosis in CHC patients. TE-FibroScan predicted significant fibrosis at cutoff value 8.5 kPa with area under the receiver operating characteristic (AUROC) 0.90, sensitivity 83%, specificity 91.5%, positive predictive value (PPV) 91.2%, and negative predictive value (NPV) 84.4%. Serum biomarkers tests showed that AP index and FibroQ had the highest diagnostic accuracy in predicting significant liver fibrosis at cutoff 4.5 and 2.7, AUROC was 0.8 and 0.8 with sensitivity 73.6% and 73.6%, specificity 70.2% and 68.1%, PPV 71.1% and 69.8%, and NPV 72.9% and 72.3%, respectively. Combined AP index and FibroQ had AUROC 0.83 with sensitivity 73.6%, specificity 80.9%, PPV 79.6%, and NPV 75.7% for predicting significant liver fibrosis. APRI, FIB-4, CDS, King score, and GUCI had intermediate accuracy in predicting significant liver fibrosis with AUROC 0.68, 0.78, 0.74, 0.74, and 0.67, respectively, while AAR had low accuracy in predicting significant liver fibrosis. TE-FibroScan is the most accurate noninvasive alternative to liver biopsy. AP index and FibroQ, either as individual tests or combined, have good accuracy in predicting significant liver fibrosis, and are better combined for higher specificity.
肝纤维化分期对慢性丙型肝炎（CHC）患者的治疗决策和预后预测至关重要。我们评估了瞬时弹性成像（TE）-FibroScan 和非侵入性血清标志物检测在 CHC 患者肝纤维化评估中的诊断准确性，以肝活检为参考。100 例未经治疗的 CHC 患者接受了肝活检、TE-FibroScan 和八项血清标志物检测；天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值（AAR）、天冬氨酸氨基转移酶与血小板比值指数（APRI）、年龄血小板指数（AP 指数）、纤维化分数（FibroQ）、纤维化 4 指数（FIB-4）、肝硬化判别评分（CDS）、King 评分和哥德堡大学肝硬化指数（GUCI）。构建受试者工作特征曲线以比较这些非侵入性方法预测 CHC 患者显著纤维化的诊断准确性。TE-FibroScan 在截断值 8.5kPa 预测显著纤维化，其受试者工作特征曲线下面积（AUROC）为 0.90，灵敏度为 83%，特异性为 91.5%，阳性预测值（PPV）为 91.2%，阴性预测值（NPV）为 84.4%。血清标志物检测显示，AP 指数和 FibroQ 在截断值 4.5 和 2.7 时具有最高的诊断准确性，AUROC 分别为 0.8 和 0.8，灵敏度分别为 73.6%和 73.6%，特异性分别为 70.2%和 68.1%，PPV 分别为 71.1%和 69.8%，NPV 分别为 72.9%和 72.3%。联合 AP 指数和 FibroQ 的 AUROC 为 0.83，灵敏度为 73.6%，特异性为 80.9%，PPV 为 79.6%，NPV 为 75.7%，用于预测显著的肝纤维化。APRI、FIB-4、CDS、King 评分和 GUCI 在预测显著肝纤维化方面具有中等准确性，AUROC 分别为 0.68、0.78、0.74、0.74 和 0.67，而 AAR 预测显著肝纤维化的准确性较低。TE-FibroScan 是肝活检最准确的非侵入性替代方法。AP 指数和 FibroQ 无论是作为单独的检测还是联合检测，在预测显著肝纤维化方面都具有良好的准确性，并且联合检测特异性更高。
