Papadopoulos Nikolaos, Vasileiadi Sofia, Papavdi Maria, Sveroni Eirini, Antonakaki Pinelopi, Dellaporta Erminia, Koutli Evangelia, Michalea Stavroula, Manolakopoulos Spilios, Koskinas John, Deutsch Melanie
1 Department of Internal Medicine, 417 Army Share Fund Hospital of Athens (Nikolaos Papadopoulos, Eirini Sveroni).
Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch).
Ann Gastroenterol. 2019 Sep-Oct;32(5):498-503. doi: 10.20524/aog.2019.0406. Epub 2019 Jul 22.
Liver disease severity must be determined before treatment of chronic hepatitis C (CHC). We evaluated the diagnostic performance of the APRI and FIB-4 scores compared to transient elastography liver stiffness (TE-LS) in detecting significant fibrosis (F3) or cirrhosis (F4).
We retrospectively enrolled 575 patients with CHC who underwent TE-LS between May 2014 and September 2018: 365 (63.5%) male, mean age 51.54±12.4 years. APRI and FIB-4 scores were compared to TE-LS.
One hundred patients (17.5%) had TE-LS values between 9 and 11.9 kPa, and were classified as F3, while 265 (46%) were classified as F4 (TE-LS ≥12 kPa). APRI and FIB-4 scores predicted F4 patients adequately using cutoff values of 0.65 (sensitivity 85.5%, specificity 77%) and 1.63 (sensitivity 91%, specificity 77%), respectively. Cutoff values of 0.64 for APRI and 1.46 for FIB-4 predicted F3/F4 patients (sensitivity 72% and 81.5%; specificity 83% and 79%, respectively). The use of these cutoff values with APRI and FIB-4 in combination adequately predicted patients with significant fibrosis or cirrhosis (positive predictive value 91.5%), while cutoff values of 0.3 and 0.98, respectively, predicted F1/F2 patients with specificity 94.5% and sensitivity 26.5%, suggesting that in 58.5% of patients TE-LS could possibly be avoided.
The APRI/FIB-4 combination performed well in predicting significant fibrosis, while FIB-4 performed well in predicting cirrhosis. These noninvasive biochemical markers could be used as screening tools instead of LS measurement, which is not widely available. Further prospective validation studies are required to confirm this finding.
在治疗慢性丙型肝炎（CHC）之前，必须确定肝脏疾病的严重程度。我们评估了与瞬时弹性成像肝脏硬度（TE-LS）相比，APRI和FIB-4评分在检测显著纤维化（F3）或肝硬化（F4）方面的诊断性能。
我们回顾性纳入了2014年5月至2018年9月期间接受TE-LS检查的575例CHC患者：365例（63.5%）为男性，平均年龄51.54±12.4岁。将APRI和FIB-4评分与TE-LS进行比较。
100例患者（17.5%）的TE-LS值在9至11.9 kPa之间，被分类为F3，而265例（46%）被分类为F4（TE-LS≥12 kPa）。APRI和FIB-4评分分别使用截断值0.65（敏感性85.5%，特异性77%）和1.63（敏感性91%，特异性77%）能充分预测F4患者。APRI的截断值0.64和FIB-4的截断值1.46能预测F3/F4患者（敏感性分别为72%和81.5%；特异性分别为83%和79%）。将这些截断值与APRI和FIB-4联合使用能充分预测显著纤维化或肝硬化患者（阳性预测值91.5%），而截断值分别为0.3和0.98能预测F1/F2患者，特异性为
