Department of Medical Biochemistry.
Department of Gastroenterology, Hitit University School of Medicine, Corum.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e121-e130. doi: 10.1097/MEG.0000000000001973.
Development of noninvasive liver fibrosis indexes has been research of interest due to the limitations of liver biopsy. Therefore, we aimed to develop and evaluate the diagnostic accuracy of a novel noninvasive index for predicting significant fibrosis, advanced fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) infection based on age and routine clinical laboratory tests.
A total of 396 treatment naïve liver biopsy performed patients were divided into training (n = 262) and validation cohorts (n = 134). Histological staging was assessed by Ishak fibrosis scoring system.
In training cohort, we developed a novel fibrosis index, GAPI, using γ-glutamyl transpeptidase (GGT), age, platelet, and international normalized ratio (INR) results. The diagnostic accuracies of alanine aminotransferase ratio, age platelet index, aspartate aminotransferase to platelet ratio index, GGT to platelet ratio index, AST to lymphocyte ratio index, fibrosis index based on the four factors, Fibro Q, Goteborg University Cirrhosis Index, King's score, Pohl score, Wang I, fibrosis index, fibrosis cirrhosis index, cirrhosis discriminant score, Lok score, Doha score, Mehdi's model, GqHBsAg, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, RDW to lymphocyte ratio, RDW to platelet ratio, GGT/INR, GGT/albumin, white blood cell/platelet distribution width (PDW), mean platelet volume/PDW and platelet/PDW indexes were compared to GAPI index. For the prediction of significant fibrosis, advanced fibrosis and cirrhosis, the area under the receiver operating characteristic curves (AUROCs) of GAPI index were 0.776, 0.868, and 0.885 in training cohort, and 0.731, 0.883, and 0.919 in validation cohort, respectively. The AUROCs of the GAPI index were higher than those of the evaluated 27 noninvasive indexes to predict significant fibrosis, advanced fibrosis, and cirrhosis.
In resource limited settings, GAPI is a promising noninvasive liver fibrosis index for predicting significant fibrosis, advanced fibrosis and cirrhosis, and for decreasing the need for liver biopsy in patients with CHB infection using cutoff points of 2.00 and 3.50.
由于肝活检的局限性，开发非侵入性肝纤维化指标一直是研究热点。因此，我们旨在开发和评估一种基于年龄和常规临床实验室检测的新型非侵入性指数，用于预测慢性乙型肝炎（CHB）感染患者的显著纤维化、进展性纤维化和肝硬化，并评估其诊断准确性。
共纳入 396 例未经治疗的肝活检患者，分为训练队列（n=262）和验证队列（n=134）。采用 Ishak 纤维化评分系统评估组织学分期。
在训练队列中，我们使用γ-谷氨酰转肽酶（GGT）、年龄、血小板和国际标准化比值（INR）结果开发了一种新型纤维化指数 GAPI。丙氨酸氨基转移酶比值、年龄血小板指数、天门冬氨酸氨基转移酶/血小板比值指数、GGT/血小板比值指数、AST/淋巴细胞比值指数、基于四个因素的纤维化指数、Fibro Q、哥德堡大学肝硬化指数、King 评分、Pohl 评分、Wang I、纤维化指数、纤维化肝硬化指数、肝硬化判别评分、Lok 评分、多哈评分、Mehdi 模型、GqHBsAg、中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值、红细胞分布宽度/淋巴细胞比值、红细胞分布宽度/血小板比值、GGT/INR、GGT/白蛋白、白细胞/血小板分布宽度（PDW）、平均血小板体积/PDW 和血小板/PDW 指数与 GAPI 指数进行比较。对于显著纤维化、进展性纤维化和肝硬化的预测，GAPI 指数的受试者工作特征曲线（AUROCs）在训练队列中的 AUC 分别为 0.776、0.868 和 0.885，在验证队列中的 AUC 分别为 0.731、0.883 和 0.919。GAPI 指数的 AUROCs 高于 27 种评估的非侵入性指数在预测显著纤维化、进展性纤维化和肝硬化方面的 AUROCs。
在资源有限的情况下，GAPI 是一种很有前途的非侵入性肝纤维化指数，可用于预测 CHB 感染患者的显著纤维化、进展性纤维化和肝硬化，并可通过使用 2.00 和 3.50 的截断值减少肝活检的需求。
