基于非侵入性血清学评分指标与瞬时弹性成像技术评估慢性丙型肝炎肝纤维化和肝硬化的一致性。

Concordance of non-invasive serology-based scoring indices and transient elastography for liver fibrosis and cirrhosis in chronic hepatitis C.

机构信息

Department for Laboratory Diagnostics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.

Department of Gastroenterology and Hepatology, Internal Medicine Hospital, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.

出版信息

Med Glas (Zenica). 2021 Feb 1;18(1):70-76. doi: 10.17392/1269-21.

DOI:10.17392/1269-21

PMID:33155459

Abstract

Aim To assess concordance of eight frequently used serology-based scoring indices for liver fibrosis and cirrhosis with transient elastography (TE) in chronic hepatitis C (CHC) patients in order to determine serum indices with the highest concordance and clinical usability in clinical practice. Methods In this prospective study, 63 CHC patients were included and TE results were compared with eight non-invasive indices. The diagnostic performance of these tests was assessed using receiver operating characteristic curves with kappa index calculated for the concordance analysis. Results Median age of 63 patients was 54 years (interquartile range: 42 to 63); 27 (42.9%) were females. According to areas under the Receiver Operating Characteristics (AUROC), the best performing serum markers for significant liver fibrosis (METAVIR ≥F2), advanced liver fibrosis (≥F3) and cirrhosis (F4) determined by TE measurements (≥7.1kPa, ≥9.5kPa and ≥12kPa, respectively) were Fibrotest (AUROC=0.727 for ≥F2) and FIB-4 score (AUROC=0.779 for ≥F3 and AUROC=0.889 for F4). Fibrotest cut-off at >0.50 was concordant with TE for presence of significant fibrosis in 30 (out of 45; 66.7%), FIB-4 cut-off at <1.45 was concordant for absence of significant fibrosis in 13 (out of 18; 72.2%) and Goeteborg University Cirrhosis Index (GUCI) cut-off at >1 was concordant for presence of cirrhosis in 16 (out of 22; 72.7%) patients, but not for exclusion of cirrhosis. Conclusion Serology-based scoring indices had moderate overall concordance with TE. We propose that FIB-4 score, Fibrotest and GUCI be used in routine practice to exclude and diagnose significant fibrosis and diagnose cirrhosis, respectively.

摘要

目的

评估八种常用于评估慢性丙型肝炎（CHC）患者肝纤维化和肝硬化的基于血清学的评分指数与瞬时弹性成像（TE）的一致性，以确定与 TE 具有最高一致性和临床实用性的血清学指数。

方法

在这项前瞻性研究中，纳入了 63 名 CHC 患者，将 TE 结果与八种非侵入性指数进行比较。使用受试者工作特征曲线评估这些测试的诊断性能，并计算kappa 指数进行一致性分析。

结果

63 名患者的中位年龄为 54 岁（四分位间距：42 至 63）；27 名（42.9%）为女性。根据接受者操作特征曲线下面积（AUROC），对于由 TE 测量确定的显著肝纤维化（METAVIR ≥F2）、进展性肝纤维化（≥F3）和肝硬化（F4），表现最佳的血清标志物是 Fibrotest（AUROC=0.727 用于≥F2）和 FIB-4 评分（AUROC=0.779 用于≥F3 和 AUROC=0.889 用于 F4）。Fibrotest 的 cutoff 值＞0.50 与 TE 用于存在显著纤维化的 30 例（45 例中的 30 例；66.7%）具有一致性，FIB-4 的 cutoff 值＜1.45 与不存在显著纤维化的 13 例（18 例中的 13 例；72.2%）具有一致性，Goeteborg 大学肝硬化指数（GUCI）的 cutoff 值＞1 与存在肝硬化的 16 例（22 例中的 16 例；72.7%）具有一致性，但不能排除肝硬化。