Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, IGTP, Universitat Autònoma de Barcelona, Badalona, Spain.
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
Drug Alcohol Depend. 2018 Jul 1;188:180-186. doi: 10.1016/j.drugalcdep.2018.04.008. Epub 2018 May 16.
HCV infection is frequent in patients with alcohol use disorder (AUD). Ethanol and hepatitis C have a synergistic effect that increases the risk of end-stage liver disease. We aimed to assess fibrosis of the liver in patients admitted to treatment of AUD.
Data were collected in two hospital units between 2000 and 2014. Liver fibrosis was assessed by serum biomarkers APRI, FIB-4 and Forns, and Advanced Liver Fibrosis (ALF) was defined if APRI > 1.5, FIB-4 > 3.25 or Forns > 6.9. Correlations were analyzed by Pearson's coefficients and logistic regression models were used.
1313 patients (80% M) had complete data; age at admission was 45 years (IQR: 39-52 yrs), age of initial regular alcohol consumption was 20 years (IQR: 17-26 yrs) and the amount of alcohol consumed preceding admission was 200 g/day (IQR: 120-270 g/day). Prevalence of HCV infection was 18%. Prevalence of ALF in HCV positive patients was 40.6% by APRI, 30.6% by FIB-4, and 43.3% by Forns. Correlations were high for APRI vs. FIB-4 r = 0.906, APRI vs. Forns r = 0.710, and, FIB-4 vs. Forns r = 0.825. There was no significant difference in the APRI/FIB-4 correlation by HCV status (z = 1.35, p = 0.177). However, the APRI/Forns correlation was significantly higher in HCV positive patients (p < 0.001). Patients with HCV infection were two times more likely to present with ALF at admission (OR = 2.1, 95%CI:1.5-3.1).
HCV infection is associated with severity of fibrosis in patients with excessive alcohol consumption. In this context, APRI and FIB-4 are highly correlated which facilitates the assessment of liver damage.
丙型肝炎病毒（HCV）感染在酒精使用障碍（AUD）患者中很常见。乙醇和丙型肝炎具有协同作用，会增加终末期肝病的风险。我们旨在评估接受 AUD 治疗的患者的肝脏纤维化程度。
数据收集于 2000 年至 2014 年在两个医院单元进行。通过血清生物标志物 APRI、FIB-4 和 Forns 评估肝纤维化，APRI>1.5、FIB-4>3.25 或 Forns>6.9 定义为高级肝纤维化（ALF）。采用 Pearson 系数分析相关性，并使用逻辑回归模型进行分析。
1313 例患者（80%为男性）有完整的数据；入院时的年龄为 45 岁（IQR：39-52 岁），首次规律饮酒的年龄为 20 岁（IQR：17-26 岁），入院前的饮酒量为 200g/天（IQR：120-270g/天）。HCV 感染率为 18%。APRI 诊断 HCV 阳性患者的 ALF 患病率为 40.6%，FIB-4 为 30.6%，Forns 为 43.3%。APRI 与 FIB-4（r=0.906）、APRI 与 Forns（r=0.710）、FIB-4 与 Forns（r=0.825）之间的相关性较高。HCV 状态对 APRI/FIB-4 相关性无显著差异（z=1.35，p=0.177）。然而，HCV 阳性患者的 APRI/Forns 相关性显著更高（p<0.001）。HCV 感染患者入院时更有可能出现 ALF（OR=2.1，95%CI：1.5-3.1）。
HCV 感染与过量饮酒患者的肝纤维化严重程度相关。在这种情况下，APRI 和 FIB-4 高度相关，有利于评估肝损伤。
