Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Med Virol. 2019 Jul;91(7):1279-1287. doi: 10.1002/jmv.25435. Epub 2019 Mar 4.
We aimed at investigating the effects of age on the predictive performances of noninvasive fibrosis scores for significant fibrosis in patients with chronic hepatitis B (CHB).
A total of 496 CHB patients who underwent liver biopsy were stratified into four age groups: ≤30, 31 to 40, 41 to 50, and ≥51 years. Receiver operating characteristic curves were used to evaluate the diagnostic performance of aspartate aminotransferase to platelet ratio index (APRI), fibrosis score-4 (Fib-4) and γ-glutamyl transpeptidase to platelet ratio (GPR) in different age groups.
The extent of fibrosis significantly increased with age, and the percentage of significant fibrosis (≥F2) was 21.3%, 29.0%, 38.5%, and 46.1%, respectively. All three scores displayed a moderate accuracy to diagnose significant fibrosis in overall patients. However, for patients with age ≤30 years, APRI, Fib-4, and GPR performed poorly with the AUROC of 0.567, 0.627 and 0.596, respectively. Furthermore, using the established cut-off values-1.45 for Fib-4, the sensitivity for significant fibrosis increased with age, from 14.8%, 38.1%, 74.5% to 97.87% in above age groups, respectively. To improve the diagnostic accuracy for significant fibrosis, the proposed low and high cut-off points for Fib-4 were 0.41 and 1.15 in ≤30 years, 0.8 and 1.59 in 31 to 40 years, 1.17 and 1.94 in 41 to 50 years, 1.76 and 3.10 in ≥ 51 years, respectively.
Age may influence the diagnostic thresholds and performance of APRI, Fib-4, and GPR for significant fibrosis in patients with CHB. In particular, these scores performed poorly for identifying significant fibrosis in younger patients (≤30 years).
本研究旨在探讨年龄对非侵入性纤维化评分预测慢性乙型肝炎（CHB）患者显著纤维化的效能的影响。
共纳入 496 例接受肝活检的 CHB 患者，将其分为 4 个年龄组：≤30 岁、31-40 岁、41-50 岁和≥51 岁。采用受试者工作特征曲线评估天门冬氨酸氨基转移酶血小板比值指数（APRI）、纤维化评分-4（Fib-4）和γ-谷氨酰转肽酶血小板比值（GPR）在不同年龄组中的诊断性能。
纤维化程度随年龄显著增加，≥F2 的纤维化比例分别为 21.3%、29.0%、38.5%和 46.1%。所有三种评分在所有患者中对诊断显著纤维化均具有中等准确性。然而，对于≤30 岁的患者，APRI、Fib-4 和 GPR 的 AUROC 分别为 0.567、0.627 和 0.596，表现不佳。此外，采用已建立的 Fib-4 截断值-1.45，随着年龄的增长，显著纤维化的敏感性从上述各年龄组的 14.8%、38.1%、74.5%分别增加至 97.87%。为了提高显著纤维化的诊断准确性，建议在≤30 岁的患者中，Fib-4 的低截断值和高截断值分别为 0.41 和 1.15，在 31-40 岁的患者中分别为 0.8 和 1.59，在 41-50 岁的患者中分别为 1.17 和 1.94，在≥51 岁的患者中分别为 1.76 和 3.10。
年龄可能会影响 APRI、Fib-4 和 GPR 对 CHB 患者显著纤维化的诊断阈值和效能。特别是，这些评分在识别年轻患者（≤30 岁）的显著纤维化方面表现不佳。
