代偿期慢性乙型肝炎患者肝硬化和显著纤维化检测的常规指标。

Routine indexes for cirrhosis and significant fibrosis detection in patients with compensated chronic hepatitis B.

机构信息

State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Disease & Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China; Department of Internal Medicine, Chencun Hospital Affiliated to Shunde Hospital, Southern Medical University, Shunde, Guangdong, China.

出版信息

Dig Liver Dis. 2019 Jan;51(1):127-134. doi: 10.1016/j.dld.2018.07.001. Epub 2018 Jul 11.

DOI:10.1016/j.dld.2018.07.001

PMID:30076017

Abstract

BACKGROUND AND AIM

Fibrosis index based on the four factors (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) were not well validated in patients with chronic hepatitis B (CHB). The aim of this study was to validate the performances of these indexes and construct novel indexes for liver fibrosis assessment.

METHODS

A total of 1438 consecutive antivirus treatment-naïve patients with CHB were analysed, and two novel indexes (named HeBCI and HeBFI) were derived for cirrhosis and significant fibrosis detection.

RESULTS

For cirrhosis, the area under receiver operating characteristic curves (AUROCs) were 0.841 for HeBCI, 0.708 for FIB-4 and 0.623 for APRI in the model set, and 0.779, 0.690, 0.595 in the validation set. For significant fibrosis, the AUROCs were 0.781 for HeBFI, 0.693 for APRI and 0.641 for FIB-4 in the model set, and 0.776, 0.729, 0.641 in the validation set. HeBCI determined 750 (52.2%) patients as having cirrhosis or non-cirrhosis with an accuracy of 86%. HeBFI detected 673 (46.8%) patients with or without significant fibrosis with an accuracy of 76.6%.

CONCLUSIONS

As economical and convenient indexes, HeBCI and HeBFI are suitable to serve as outpatient tools for detecting significant fibrosis and cirrhosis to reduce the need of liver biopsy significantly in resource-limited settings.

摘要

背景与目的

纤维化指数基于四个因素（FIB-4）和天冬氨酸氨基转移酶与血小板比值指数（APRI）在慢性乙型肝炎（CHB）患者中尚未得到充分验证。本研究旨在验证这些指标的性能，并构建用于评估肝纤维化的新型指标。

方法

对 1438 例连续抗病毒治疗初治的 CHB 患者进行分析，并为肝硬化和显著纤维化检测衍生了两个新型指标（分别命名为 HeBCI 和 HeBFI）。

结果

对于肝硬化，HeBCI 的曲线下面积（AUROC）在模型组为 0.841，FIB-4 为 0.708，APRI 为 0.623，在验证组中分别为 0.779、0.690、0.595。对于显著纤维化，HeBFI 的 AUROC 在模型组为 0.781，APRI 为 0.693，FIB-4 为 0.641，在验证组中分别为 0.776、0.729、0.641。HeBCI 确定 750 例（52.2%）患者患有或不患有肝硬化，准确率为 86%。HeBFI 检测到 673 例（46.8%）患者有无显著纤维化，准确率为 76.6%。