Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Public Health Bureau, Tainan City Government, Tainan, Taiwan.
PLoS One. 2018 Nov 7;13(11):e0206947. doi: 10.1371/journal.pone.0206947. eCollection 2018.
The role of non-invasive methods to evaluate fibrosis severity of chronic hepatitis C (CHC) subjects in community needs to be explored. This study investigated FIB-4 and transient elastography (TE) in staging liver fibrosis of CHC subjects in community.
A total of 905 subjects who were positive for anti-HCV antibody from five districts of Tainan City of Taiwan were invited to participate in surveillance activities for CHC. FIB-4 and TE were measured for each participant.
A total of 502 subjects with detectable HCV RNA and valid TE were enrolled. The distribution of FIB-4 and TE values differed markedly. Both methods exhibited a strongest correlation in subjects with at age 50~60 years (r = 0.655, p <0.001). FIB-4 score increased proportionally with age (p <0.001), but TE did not (p = 0.142). The intraclass correlation efficient of both methods was 0.255 (p <0.001). Subjects with TE defined advanced fibrosis exhibited younger age, higher BMI, higher platelet count, lower FIB-4 score, higher incidence of fatty liver and splenomegaly, and higher controlled attenuation parameter value than those defined by FIB-4. By multivariate logistic regression analysis, higher ALT levels, higher incidence of fatty liver, and presence of splenomegaly were the independent factors associated with advanced fibrosis defined by TE rather than defined by FIB-4.
FIB-4 and TE defined different distribution of fibrosis stages in same HCV population. FIB-4 was deeply influenced by age whereas TE was not. TE had the advantages over than FIB-4 in strong association with splenomegaly and in detecting the role of non-alcoholic fatty liver disease in advanced fibrosis.
需要探索非侵入性方法在社区中评估慢性丙型肝炎（CHC）患者纤维化严重程度的作用。本研究调查了 FIB-4 和瞬时弹性成像（TE）在社区 CHC 患者肝纤维化分期中的作用。
共邀请了台湾台南市五个区的 905 名抗 HCV 抗体阳性者参加 CHC 监测活动。对每位参与者进行了 FIB-4 和 TE 测量。
共纳入了 502 名可检测到 HCV RNA 和有效 TE 的患者。FIB-4 和 TE 值的分布差异明显。两种方法在年龄为 50~60 岁的患者中相关性最强（r = 0.655，p <0.001）。FIB-4 评分随年龄呈比例增加（p <0.001），但 TE 则没有（p = 0.142）。两种方法的组内相关系数为 0.255（p <0.001）。TE 定义的晚期纤维化患者比 FIB-4 定义的晚期纤维化患者年龄更小、BMI 更高、血小板计数更高、FIB-4 评分更低、脂肪肝和脾肿大的发生率更高、受控衰减参数值更高。通过多变量逻辑回归分析，较高的 ALT 水平、较高的脂肪肝发生率和脾肿大的存在是与 TE 定义的而不是 FIB-4 定义的晚期纤维化相关的独立因素。
FIB-4 和 TE 在同一 HCV 人群中定义了不同的纤维化分期分布。FIB-4 受年龄影响较大，而 TE 则不受影响。TE 在与脾肿大强烈相关以及在检测非酒精性脂肪性肝病在晚期纤维化中的作用方面优于 FIB-4。
