Çelik D, Tatar B, Köse Ş, Ödemiş İ
Çigli Education and Research Hospital, Izmir, Turkey.
Baskent University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey.
Acta Gastroenterol Belg. 2020 Jul-Sep;83(3):419-425.
The aim of this study was to evaluate the effectiveness of noninvasive tests in predicting liver fibrosis levels in chronic hepatitis B (CHB) patients.
A total of 539 treatment naive patients aged 18 years and older with CHB who underwent liver biopsy were included. Patients with coinfections and comorbidities were excluded. Data were obtained retrospectively from patient' follow- up files. Liver biopsy was evaluated according to the Ishak scoring system. SPSS 22.0 program was used for statistical analysis. Diagnostic sensitivity of APRI, FIB-4, NLR, GPR, AAR, RPR, API, King's score, Fibro Q and MPV was determined for predicting ≥F2, ≥F3, ≥F4, ≥F5 groups.
The median age of the CHB patients was 41 ±11.57 / year and 49.2% of the patients were female. The distribution of fibrosis stages was : F0, 16.5% ; F1, 26.4% ; F2, 39.7% ; F3, 10.4% ; F4, 4.1% ; F5, 2.4% ; F6 0.4%. Age, AST, ALT, GGT, ALP, RDW, HBV DNA levels were significantly higher, platelet and albumin levels were significantly lower in the ≥F3 group. All noninvasive tests except NLR and AAR predicted ≥F3 adequately (AUROC >0.5). King's score for predicting ≥F2, ≥F5, and GPR for predicting ≥F3 had the highest diagnostic power. The tests predicted the fibrosis stage better, as the fibrosis stage progressed.
As a result, most of the noninvasive tests we evaluated could predict significant fibrosis and cirrhosis with significant accuracy. The rate of unnecessary biopsies can be reduced with the help of these noninvasive tests.
本研究旨在评估非侵入性检测在预测慢性乙型肝炎（CHB）患者肝纤维化水平方面的有效性。
纳入539例年龄≥18岁、初治的CHB患者，均接受了肝活检。排除合并感染及其他疾病的患者。数据通过回顾患者随访档案获得。肝活检依据Ishak评分系统进行评估。采用SPSS 22.0软件进行统计分析。测定APRI、FIB-4、NLR、GPR、AAR、RPR、API、King评分、Fibro Q及MPV对预测≥F2、≥F3、≥F4、≥F5组的诊断敏感性。
CHB患者的中位年龄为41±11.57岁/年，49.2%为女性。纤维化分期分布为：F0，16.5%；F1，26.4%；F2，39.7%；F3，10.4%；F4，4.1%；F5，2.4%；F6，0.4%。≥F3组患者的年龄、AST、ALT、GGT、ALP、RDW、HBV DNA水平显著更高，血小板及白蛋白水平显著更低。除NLR和AAR外，所有非侵入性检测对≥F3的预测均较为充分（AUROC>0.5）。预测≥F2、≥F5的King评分及预测≥F3的GPR具有最高的诊断效能。随着纤维化分期进展，这些检测对纤维化分期的预测效果更佳。
因此，我们评估的大多数非侵入性检测能够较为准确地预测显著纤维化和肝硬化。借助这些非侵入性检测可降低不必要肝活检的比例。
