新型非侵入性评分模型预测丙型肝炎消除时代的肝硬化：新加坡药物滥用者的人群研究。
Novel non-invasive score to predict cirrhosis in the era of hepatitis C elimination: A population study of ex-substance users in Singapore.
机构信息
Department of Gastroenterology and Hepatology, Changi General Hospital, Singhealth, Singapore 529889, Singapore.
Department of Gastroenterology and Hepatology, Changi General Hospital, Singhealth, Singapore 529889, Singapore.
出版信息
Hepatobiliary Pancreat Dis Int. 2019 Apr;18(2):143-148. doi: 10.1016/j.hbpd.2018.12.002. Epub 2018 Dec 6.
BACKGROUND
Chronic hepatitis C infection is common among people with history of substance use. Liver fibrosis assessment is a barrier to linkage to care, particularly among those with history of substance users. The use of non-invasive scores can be helpful in predicting liver cirrhosis in the era of HCV elimination, especially in countries where transient elastography (TE) is not available. We compared the commonly used non-invasive scores with a novel non-invasive score in predicting liver cirrhosis in this population.
METHODS
HCV patients with history of substance use between 2011 and 2016 were analyzed. All patients had TE for liver fibrosis assessment. Clinical performance of established non-invasive scores for fibrosis assessment and novel score were compared. Youden's index was used to determine optimal cut-off of the novel score.
RESULTS
A total of 579 patients were included. In multivariate logistic regression, cirrhosis on TE was associated with age (P = 0.002), aspartate aminotransferase (AST) (P = 0.004), and platelet count (P < 0.001), but not alanine aminotransferase (ALT) (P = 0.896). These form the components of modified AST-to-platelet ratio index (APRI) score. Modified APRI was superior to APRI in predicting cirrhosis (AUROC, 0.796 vs. 0.770, P = 0.007), but not fibrosis-4 score (FIB-4) (P = 1.00). Modified APRI at cut-off of 4 has sensitivity, specificity and negative predictive value (NPV) of 94.4%, 26.9% and 92.6%, respectively, and at 19, has sensitivity, specificity and positive predictive value (PPV) of 33.3%, 96.2% and 77.1%, respectively. FIB-4 has a NPV and PPV of 88.6%, 41.8% and 78.5%, 77.6%, at cut-off of 1.45 and 3.25, respectively. Using the cut-off of 4 and 14 for modified APRI, 32.5% of patients can be correctly classified and misses out only 5.6% of cirrhosis patients.
CONCLUSIONS
Modified APRI score is superior in predicting cirrhosis in HCV population, with 32.5% of the population being correctly classified using cut-off of 4 and 14. Further studies are required to validate the findings.
背景
慢性丙型肝炎感染在有药物使用史的人群中很常见。肝纤维化评估是联系治疗的障碍，尤其是在有药物使用史的人群中。在丙型肝炎消除时代，使用非侵入性评分可以帮助预测肝硬化，特别是在瞬态弹性成像（TE）不可用的国家。我们比较了常用的非侵入性评分与一种新的非侵入性评分在预测该人群肝硬化中的作用。
方法
分析了 2011 年至 2016 年间有药物使用史的丙型肝炎病毒（HCV）患者。所有患者均接受 TE 进行肝纤维化评估。比较了用于纤维化评估的既定非侵入性评分和新评分的临床性能。使用约登指数确定新评分的最佳截断值。
结果
共纳入 579 例患者。多变量逻辑回归显示，TE 上的肝硬化与年龄（P=0.002）、天冬氨酸转氨酶（AST）（P=0.004）和血小板计数（P<0.001）相关，但与丙氨酸转氨酶（ALT）（P=0.896）无关。这些构成改良 AST 与血小板比值指数（APRI）评分的组成部分。改良 APRI 优于 APRI 预测肝硬化（AUROC，0.796 比 0.770，P=0.007），但纤维化-4 评分（FIB-4）（P=1.00）除外。改良 APRI 截断值为 4 时，灵敏度、特异性和阴性预测值（NPV）分别为 94.4%、26.9%和 92.6%，截断值为 19 时，灵敏度、特异性和阳性预测值（PPV）分别为 33.3%、96.2%和 77.1%。FIB-4 的 NPV 和 PPV 分别为 88.6%、41.8%和 78.5%、77.6%，截断值分别为 1.45 和 3.25。使用改良 APRI 的截断值 4 和 14，32.5%的患者可以正确分类，仅漏诊 5.6%的肝硬化患者。
结论
改良 APRI 评分在预测 HCV 人群中的肝硬化方面更具优势，使用截断值 4 和 14，32.5%的人群可以正确分类，仅漏诊 5.6%的肝硬化患者。需要进一步的研究来验证这些发现。
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