M2BPGi 用于评估丙型肝炎直接作用抗病毒药物治疗患者的肝纤维化。
M2BPGi for assessing liver fibrosis in patients with hepatitis C treated with direct-acting antivirals.
机构信息
Gastroenterology and Hepatology Unit, Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt.
出版信息
World J Gastroenterol. 2020 Jun 7;26(21):2864-2876. doi: 10.3748/wjg.v26.i21.2864.
BACKGROUND
Assessing liver fibrosis is important for predicting the efficacy of direct-acting antivirals (DAAs) and patient prognosis. Non-invasive techniques to assess liver fibrosis are becoming important. Recently, serum Mac-2 binding protein glycosylation isomer (M2BPGi) was identified as a non-invasive marker of liver fibrosis.
AIM
To investigate the diagnostic accuracy of M2BPGi in assessing liver fibrosis in patients with chronic hepatitis C (CHC) treated with DAAs.
METHODS
From December 2017 to August 2018, 80 treatment-naïve adult patients with CHC who were eligible for DAAs therapy were consecutively enrolled in this observational cohort study. For 12 weeks, 65 patients were treated with sofosbuvir/daclatasvir, and 15 patients were treated with sofosbuvir/daclatasvir and a weight-based dose of ribavirin at knowledge and technology association for hepatitis C management clinic, Cairo, Egypt. We measured serum M2BPGi levels, PAPAS index, fibrosis-4 (FIB-4) score and liver stiffness measurements (LSM) at baseline and 12 weeks after the end of treatment. Serum M2BPGi levels were measured using enzyme-linked immunosorbent assay.
RESULTS
All patients achieved sustained virologic response (SVR12) (100%). Serum M2BPGi levels, LSM, FIB-4 score and PAPAS index decreased significantly at SVR12 ( < 0.05). Serum M2BPGi levels correlated positively with LSM at baseline and SVR12 ( < 0.001). At baseline, compared with the FIB-4 score and PAPAS index, M2BPGi was the best marker to distinguish patients with grade F4 fibrosis (AUC = 0.801, < 0.001), patients with grade F2 from grade F0-1 fibrosis (AUC = 0.713, = 0.012), patients with grade F3-4 from grade F0-2 fibrosis (AUC = 0.730, < 0.001), and patients with grade F2-4 from grade F0-1 fibrosis (AUC = 0.763, < 0.001). At SVR12, M2BPGi had the greatest AUCs for differentiating patients with grade F4 fibrosis (AUC = 0.844, < 0.001), patients with grade F3 from grade F0-2 fibrosis (AUC = 0.893, = 0.002), patients with grade F3-4 from grade F0-2 fibrosis (AUC = 0.891, < 0.001), and patients with grade F2-4 from grade F0-1 fibrosis (AUC = 0.750, < 0.001).
CONCLUSION
M2BPGi is a reliable marker for the non-invasive assessment and prediction of liver fibrosis regression in patients with CHC who achieved an SVR with DAAs therapy.
背景
评估肝纤维化对于预测直接作用抗病毒药物（DAA）的疗效和患者预后非常重要。评估肝纤维化的非侵入性技术正变得越来越重要。最近，血清 Mac-2 结合蛋白糖基化异构体（M2BPGi）被鉴定为肝纤维化的非侵入性标志物。
目的
研究 M2BPGi 在评估 DAA 治疗的慢性丙型肝炎（CHC）患者肝纤维化中的诊断准确性。
方法
2017 年 12 月至 2018 年 8 月，连续纳入 80 名符合 DAA 治疗条件的初治成年 CHC 患者进行这项观察性队列研究。在埃及开罗的知识和技术协会丙型肝炎管理诊所，65 名患者接受了索非布韦/达卡他韦治疗，15 名患者接受了索非布韦/达卡他韦联合基于体重的利巴韦林治疗。我们在基线和治疗结束后 12 周时测量了血清 M2BPGi 水平、PAPAS 指数、纤维化-4（FIB-4）评分和肝硬度测量值（LSM）。使用酶联免疫吸附试验测量血清 M2BPGi 水平。
结果
所有患者均获得持续病毒学应答（SVR12）（100%）。血清 M2BPGi 水平、LSM、FIB-4 评分和 PAPAS 指数在 SVR12 时显著降低（<0.05）。血清 M2BPGi 水平与基线和 SVR12 时的 LSM呈正相关（<0.001）。在基线时，与 FIB-4 评分和 PAPAS 指数相比，M2BPGi 是区分 F4 纤维化患者的最佳标志物（AUC=0.801，<0.001），是区分 F2 与 F0-1 纤维化患者的最佳标志物（AUC=0.713，=0.012），是区分 F3-4 与 F0-2 纤维化患者的最佳标志物（AUC=0.730，<0.001），是区分 F2-4 与 F0-1 纤维化患者的最佳标志物（AUC=0.763，<0.001）。在 SVR12 时，M2BPGi 区分 F4 纤维化患者的 AUC 值最大（AUC=0.844，<0.001），区分 F3 与 F0-2 纤维化患者的 AUC 值最大（AUC=0.893，=0.002），区分 F3-4 与 F0-2 纤维化患者的 AUC 值最大（AUC=0.891，<0.001），区分 F2-4 与 F0-1 纤维化患者的 AUC 值最大（AUC=0.750，<0.001）。
结论
M2BPGi 是一种可靠的标志物，可用于评估 DAA 治疗的 CHC 患者肝纤维化的非侵入性评估和预测。
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