Afify Said M, Tabll Ashraf, Nawara Hend M, El Kassas Mohamed, Elfert Ashraf, Seno Masaharu, El-Kousy Salah
Clin Lab. 2018 Oct 1;64(10):1685-1693. doi: 10.7754/Clin.Lab.2018.180502.
Liver fibrosis is a dynamic procedure that results from an irregularity between fibrogenesis and fibrolysis. After time this procedure can lead to cirrhosis of the liver. Liver fibrosis and cirrhosis assessment is very important for both therapeutic decisions and prognostic evaluations. In this study, we tried to use serum ferritin (SF) together with five fibrosis tests (Age-Platelet index (API), aspartate aminotransferase to alanine aminotransferase ratio (AAR), AST to platelet ratio index (APRI), Fibrosis 4 score (FIB-4), and fibro-quotient (Fibro-Q)) to assess liver fibrosis and cirrhosis and estimate possible correlation between inflammation and SF.
This study was carried out on eighty-eight patients infected with HCV and twenty healthy subjects as a control. Complete blood count (CBC), aspartate aminotransferase (AST), alanine aminotransferase (ALT), antiHCV antibody, detection of HCV RNA by real-time PCR, and serum ferritin (SF) were assessed. Then API, ARR, APRI, FIB-4, and Fibro-Q were calculated. Different fibrosis stages (mild fibrosis stage (F1), moderate fibrosis stage (F2), severe fibrosis stage (F3), cirrhotic stage (F4)) were assessed using transient elastography by Fibro Scan®.
FIB-4 index was significantly elevated (p < 0.01) with the progression of liver fibrosis at F1, F2, F3, and F4 when compared to healthy control group. The APRI score elevation between F0 and F3 and between F0 and F4 was significant (p < 0.01). SF was elevated in all fibrosis stages and significantly (p < 0.01) at F3 and F4 compared to controls.
APRI coupled with SF should be the best reliable biomarkers for liver cirrhosis. Simultaneously, from our data SF involved in all stages of inflammation. Therefore, down regulation of ferritin in the early stage of fibrosis should be helpful in decreasing the inflammatory effect of ferritin.
肝纤维化是一种动态过程，由纤维生成与纤维溶解之间的失衡所致。随着时间推移，这一过程可导致肝硬化。肝纤维化和肝硬化评估对于治疗决策和预后评估均非常重要。在本研究中，我们尝试将血清铁蛋白（SF）与五项纤维化检测指标（年龄-血小板指数（API）、天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值（AAR）、AST与血小板比值指数（APRI）、纤维化4评分（FIB-4）以及纤维商数（Fibro-Q））联合使用，以评估肝纤维化和肝硬化，并估计炎症与SF之间可能存在的相关性。
本研究对88例丙型肝炎病毒（HCV）感染患者及20名健康受试者作为对照进行。评估全血细胞计数（CBC）、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、抗HCV抗体、通过实时聚合酶链反应检测HCV RNA以及血清铁蛋白（SF）。然后计算API、ARR、APRI、FIB-4和Fibro-Q。使用Fibro Scan®通过瞬时弹性成像评估不同的纤维化阶段（轻度纤维化阶段（F1）、中度纤维化阶段（F2）、重度纤维化阶段（F3）、肝硬化阶段（F4））。
与健康对照组相比，FIB-4指数在F1、F2、F3和F4阶段随着肝纤维化进展显著升高（p < 0.01）。APRI评分在F0与F3之间以及F0与F4之间升高显著（p < 0.01）。SF在所有纤维化阶段均升高，与对照组相比，在F3和F4阶段显著升高（p < 0.01）。
APRI与SF联合应是肝硬化最可靠的生物标志物。同时，从我们的数据来看，SF参与炎症的各个阶段。因此，在纤维化早期下调铁蛋白应有助于降低铁蛋白的炎症效应。
