Mada Pradeep Kumar, Malus Matthew E, Saldaña Koppel Daniel Alexander, Adley Sharon, Moore Maureen, Alam Mohammed J, Feldman Mark
Infectious Diseases, Louisiana State University Health Sciences Center, Shreveport, USA.
Internal Medicine, Texas Health Presbyterian Hospital, Dallas, USA.
Cureus. 2020 Sep 11;12(9):e10376. doi: 10.7759/cureus.10376.
Background Due to the slow progression of many chronic liver diseases, including hepatitis C, it is not practical or safe to monitor disease progression by serial liver biopsies. Noninvasive laboratory scoring systems based on routine laboratory tests are appealing surrogate markers of liver fibrosis for the staging and monitoring of chronic liver diseases such as hepatitis C. Methods We explored the accuracy of three scoring systems: the fibrosis-4 score (FIB-4), the aspartate aminotransferase to platelet ratio index (APRI score), and the aspartate aminotransferase to alanine aminotransferase ratio (AAR) in 496 patients with chronic hepatitis C virus (HCV) infection who had undergone percutaneous liver biopsy at a viral hepatitis clinic in Shreveport, Louisiana. Results For FIB-4, the area under the receiver operating characteristic curve (AUROC) for hepatic fibrosis stages ≥ 1, ≥ 2, ≥ 3, and 4 (cirrhosis) ranged from 0.74 (95% CI, 0.678 - 0.802) to 0.802 (95% CI, 0.751 - 0.854). At a cutoff value of 1.45, FIB-4 was 82% sensitive for advanced fibrosis or cirrhosis (stage 3 or 4) but was only 58% specific for these findings. Increasing the FIB-4 cutoff value to 3.25 reduced the sensitivity for detecting advanced fibrosis or cirrhosis to 39%, but this higher cutoff was 92% specific for these findings. Corresponding AUROCs for the APRI and AAR scores were inferior to FIB-4. Conclusion The FIB-4 index outperformed APRI and AAR in our HCV infected population in predicting severe fibrosis or cirrhosis.
由于包括丙型肝炎在内的许多慢性肝病进展缓慢，通过系列肝活检来监测疾病进展既不实用也不安全。基于常规实验室检查的非侵入性实验室评分系统，对于丙型肝炎等慢性肝病的分期和监测而言，是颇具吸引力的肝纤维化替代标志物。方法：我们在路易斯安那州什里夫波特市一家病毒性肝炎诊所，对496例接受过经皮肝活检的慢性丙型肝炎病毒（HCV）感染患者，探讨了三种评分系统的准确性：纤维化-4评分（FIB-4）、天冬氨酸转氨酶与血小板比值指数（APRI评分）以及天冬氨酸转氨酶与丙氨酸转氨酶比值（AAR）。结果：对于FIB-4，肝纤维化≥1期、≥2期、≥3期和4期（肝硬化）的受试者工作特征曲线下面积（AUROC）范围为0.74（95%CI，0.678 - 0.802）至0.802（95%CI，0.751 - 0.854）。在临界值为1.45时，FIB-4对晚期纤维化或肝硬化（3期或4期）的敏感性为82%，但对这些结果的特异性仅为58%。将FIB-4临界值提高到3.25，检测晚期纤维化或肝硬化的敏感性降至39%，但这个更高的临界值对这些结果的特异性为92%。APRI和AAR评分的相应AUROC低于FIB-4。结论：在我们的HCV感染人群中，FIB-4指数在预测严重纤维化或肝硬化方面优于APRI和AAR。
