1Research Center for Tropical Medicine of Rondônia, Porto Velho, Brazil.
2Department of Infectious Diseases, University of São Paulo, School of Medicine, Brazil.
Am J Trop Med Hyg. 2020 Jul;103(1):169-174. doi: 10.4269/ajtmh.19-0688. Epub 2020 May 14.
Hepatitis D virus (HDV) genotype III is endemic in the western Amazon basin and is considered to cause the most severe form of chronic viral hepatitis. Recently, noninvasive fibrosis scores to determine the stage of liver fibrosis have been evaluated in individuals positive for HDV genotype I, but their utility in HDV genotype III-positive patients is unknown. In this retrospective study conducted in an outpatient viral hepatitis referral clinic in the Brazilian Amazon region, the aspartate aminotransferase (AST) to Aspartate aminotransferase to Platelet Ratio Index (APRI) and Fibrosis Index for Liver Fibrosis (FIB-4) values were calculated and compared with histological fibrosis stages. Among the 50 patients analyzed, the median age at liver biopsy was 35.6 years, 66% were male, and all had compensated liver disease. Histological staging revealed fibrosis stages 0, 1, 2, 3, and 4 in four (8%), eight (16%), 11 (22), 11 (22%), and 16 (32%) patients, respectively. The area under the receiver operating curve (AUROC) of AST-to-alanine aminotransferase (ALT) ratio, APRI, and FIB-4 for detection of significant fibrosis (F ≥ 2) was 0.550 ( = 0.601), 0.853 ( < 0.001), and 0.853 ( < 0.0001), respectively. Lower AUROC values were obtained for cirrhosis: the AST-to-ALT ratio was 0.640 ( = 0.114), APRI was 0.671 ( = 0.053), and FIB-4 was 0.701 ( = 0.023). The optimal cutoff value for significant fibrosis for APRI was 0.708 (sensitivity 84% and specificity 92%) and for FIB-4 was 1.36 (sensitivity 76% and specificity 92%). Aspartate aminotransferase to Platelet Ratio Index and FIB-4 were less useful to predict cirrhosis. In contrast to recent reports from Europe and North America, both APRI and FIB-4 may identify significant fibrosis in HDV-III-infected patients from northwestern Brazil.
丁型肝炎病毒（HDV）基因型 III 在地中海盆地西部流行，被认为是引起最严重形式的慢性病毒性肝炎的原因。最近，已经评估了针对 HDV 基因型 I 阳性个体的非侵入性纤维化评分以确定肝纤维化的阶段，但它们在 HDV 基因型 III 阳性患者中的效用尚不清楚。在巴西亚马逊地区的门诊病毒性肝炎转诊诊所进行的这项回顾性研究中，计算了天门冬氨酸氨基转移酶（AST）与天冬氨酸氨基转移酶到血小板比值指数（APRI）和纤维化指数用于肝纤维化（FIB-4）的值，并与组织学纤维化阶段进行了比较。在分析的 50 名患者中，肝活检时的中位年龄为 35.6 岁，66%为男性，且均患有代偿性肝病。组织学分期显示纤维化分期 0、1、2、3 和 4 分别在四名（8%）、八名（16%）、十一名（22%）、十一名（22%）和十六名（32%）患者中。AST 与丙氨酸氨基转移酶（ALT）比值、APRI 和 FIB-4 检测显著纤维化（F ≥ 2）的受试者工作特征曲线下面积（AUROC）分别为 0.550（= 0.601）、0.853（< 0.001）和 0.853（< 0.0001）。对于肝硬化，AUROC 值较低：AST 与 ALT 比值为 0.640（= 0.114），APRI 为 0.671（= 0.053），FIB-4 为 0.701（= 0.023）。APRI 用于显著纤维化的最佳截断值为 0.708（敏感性 84%和特异性 92%），FIB-4 为 1.36（敏感性 76%和特异性 92%）。APRI 和 FIB-4 对于预测肝硬化的作用不大。与欧洲和北美的最近报告相反，APRI 和 FIB-4 均可识别来自巴西西北部的 HDV-III 感染患者的显著纤维化。
