Lee Jia-Jung, Wei Yu-Ju, Lin Ming-Yen, Niu Sheng-Wen, Hsu Po-Yao, Huang Jiun-Chi, Jang Tyng-Yuan, Yeh Ming-Lun, Huang Ching-I, Liang Po-Cheng, Lin Yi-Hung, Hsieh Ming-Yen, Hsieh Meng-Hsuan, Chen Szu-Chia, Dai Chia-Yen, Lin Zu-Yau, Chen Shinn-Cherng, Huang Jee-Fu, Chang Jer-Ming, Hwang Shang-Jyh, Huang Chung-Feng, Chiu Yi-Wen, Chuang Wan-Long, Yu Ming-Lung
Nephrology Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Faculty of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
PLoS One. 2020 Nov 20;15(11):e0242601. doi: 10.1371/journal.pone.0242601. eCollection 2020.
The accurate assessment of liver fibrosis among hemodialysis patients with chronic hepatitis C (CHC) is important for both treatment and for follow up strategies. Applying the non-invasive methods in general population with viral hepatitis have been successful but the applicability of the aminotransferase/platelet ratio index (APRI) or the fibrosis-4 index (FIB-4) in hemodialysis patients need further evaluation.
We conducted a prospective, multi-center, uremic cohort to verify the applicability of APRI and FIB-4 in identifying liver fibrosis by reference with the standard transient elastography (TE) measures.
There were 116 CHC cases with valid TE were enrolled in our analysis. 46 cases (39.6%) were classified as F1, 35 cases (30.2%) as F2, 11 cases (9.5%) as F3, and 24 cases (20.7%) as F4, respectively. The traditional APRI and FIB-4 criteria did not correctly identify liver fibrosis. The optimal cut-off value of APRI was 0.28 and of FIB-4 was 1.91 to best excluding liver cirrhosis with AUC of 76% and 77%, respectively. The subgroup analysis showed that female CHC hemodialysis patients had better diagnostic accuracy with 74.1% by APRI. And CHC hemodialysis patients without hypertension had better diagnostic accuracy with 78.6% by FIB-4.
This study confirmed the traditional category level of APRI and FIB-4 were unable to identify liver fibrosis of CHC hemodialysis patients. With the adjusted cut-off value, APRI and FIB-4 still showed suboptimal diagnostic accuracy. Our results suggest the necessary of TE measures for liver fibrosis in the CHC uremic population.
准确评估慢性丙型肝炎（CHC）血液透析患者的肝纤维化对于治疗和随访策略都很重要。在普通病毒性肝炎人群中应用非侵入性方法已取得成功，但天冬氨酸氨基转移酶/血小板比值指数（APRI）或纤维化-4指数（FIB-4）在血液透析患者中的适用性需要进一步评估。
我们进行了一项前瞻性、多中心的尿毒症队列研究，以参照标准瞬时弹性成像（TE）测量来验证APRI和FIB-4在识别肝纤维化方面的适用性。
我们的分析纳入了116例具有有效TE结果的CHC病例。分别有46例（39.6%）被分类为F1，35例（30.2%）为F2，11例（9.5%）为F3，24例（20.7%）为F4。传统的APRI和FIB-4标准未能正确识别肝纤维化。APRI的最佳截断值为0.28，FIB-4的最佳截断值为1.91，以最佳排除肝硬化，其曲线下面积（AUC）分别为76%和77%。亚组分析显示，女性CHC血液透析患者使用APRI的诊断准确性更高，为74.1%。无高血压的CHC血液透析患者使用FIB-4的诊断准确性更高，为78.6%。
本研究证实，传统分类水平的APRI和FIB-4无法识别CHC血液透析患者的肝纤维化。调整截断值后，APRI和FIB-4的诊断准确性仍不理想。我们的结果表明，对于CHC尿毒症人群的肝纤维化，有必要采用TE测量。
