Imai H, Kamei H, Onishi Y, Ishizu Y, Ishigami M, Goto H, Ogura Y
Department of Transplantation Surgery, Nagoya University School of Medicine, Nagoya, Japan.
Department of Gastroenterology and Hepatology, Nagoya University School of Medicine, Nagoya, Japan.
Transplant Proc. 2018 Jun;50(5):1431-1436. doi: 10.1016/j.transproceed.2018.03.005. Epub 2018 Apr 25.
Aspartate transaminase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) are well known as representative indirect serum biomarkers related to liver fibrosis. The usefulness of these markers for the diagnosis of liver fibrosis after liver transplantation (LT) in hepatitis C virus (HCV)-infected patients and the influence of splenectomy were investigated.
From June 2003 to May 2014, 31 HCV-infected patients who underwent LT and postoperative follow-up liver biopsies were included in this study. The association between liver fibrosis and serum biomarkers and the influence of splenectomy on APRI and FIB-4 were also investigated.
A total of 195 biopsy specimens were collected, and liver fibrosis was identified as: F0, 59.7%; F1, 34.1%; and F2, 6.3%. Both APRI and FIB-4 were significantly higher in patients who showed F1 and F2 in liver biopsy specimen than F0 (P values, .009 and .022, respectively); sensitivity and specificity of APRI were, respectively, 63.4% and 66.7%, and those of FIB-4 were 57.7% and 69.6%. In 11 patients (35.5%) who underwent splenectomy at the time of LT, the cutoff values for APRI and FIB-4 were 0.61 and 1.41, which were significantly lower than the corresponding values (1.00 and 3.64) of patients without splenectomy.
APRI and FIB-4 could effectively estimate liver fibrosis after LT for HCV-related liver disease. For LT patients with splenectomy, APRI and FIB-4 were also useful to estimate liver fibrosis, but the standard values should be adjusted lower than those for patients without splenectomy.
天冬氨酸转氨酶与血小板比值指数（APRI）和纤维化-4（FIB-4）是众所周知的与肝纤维化相关的代表性间接血清生物标志物。本研究探讨了这些标志物在丙型肝炎病毒（HCV）感染患者肝移植（LT）后肝纤维化诊断中的应用价值以及脾切除术的影响。
2003年6月至2014年5月，本研究纳入了31例接受LT并进行术后随访肝活检的HCV感染患者。同时研究了肝纤维化与血清生物标志物之间的关联以及脾切除术对APRI和FIB-4的影响。
共收集了195份活检标本，肝纤维化情况如下：F0为59.7%；F1为34.1%；F2为6.3%。肝活检标本显示为F1和F2的患者，其APRI和FIB-4均显著高于F0患者（P值分别为0.009和0.022）；APRI的敏感性和特异性分别为63.4%和66.7%，FIB-4的敏感性和特异性分别为57.7%和69.6%。在LT时接受脾切除术的11例患者（35.5%）中，APRI和FIB-4的临界值分别为0.61和1.41，显著低于未接受脾切除术患者的相应值（1.00和3.64）。
APRI和FIB-4可有效评估HCV相关肝病LT后的肝纤维化情况。对于接受脾切除术的LT患者，APRI和FIB-4也可用于评估肝纤维化，但标准值应调整得低于未接受脾切除术的患者。
