Unidad de Gastroenterología y Endoscopia Digestiva, Departamento de Medicina Interna, Hospital Universitario San Ignacio, Bogotá, Colombia; Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
Unidad de Gastroenterología y Endoscopia Digestiva, Departamento de Medicina Interna, Hospital Universitario San Ignacio, Bogotá, Colombia.
Gastroenterol Hepatol. 2021 Aug-Sep;44(7):465-471. doi: 10.1016/j.gastrohep.2020.07.005. Epub 2021 Feb 16.
It has been proposed that non-invasive methods may replace liver biopsy for the diagnosis of tissue damage in patients with autoimmune liver disease (ALD). The aim of this study was to determine diagnostic performance and degree of concordance between the APRI index and liver biopsy for diagnosing cirrhosis in these patients.
In a cohort of patients with ALD, the value of the APRI index and liver biopsy results were determined according to the METAVIR score. The AUC and the degree of concordance between an APRI value >2 and a METAVIR score of F4 were evaluated as markers of liver cirrhosis, through a kappa statistic.
In total, 70 patients (age 51 ± 13 years) were included. The most common autoimmune liver diseases were primary biliary cirrhosis (PBC) (40%), autoimmune hepatitis (AIH) (24.3%) and AIH-PBC overlap syndrome (32.9%). Cirrhosis was confirmed by biopsy in 16 patients (22.9%). 15 patients (21.4%) had an APRI index >2 (Cirrhosis) and only six met both criteria. The AUC of the APRI was 0.77 (95% CI 0.65-0.88). The degree of concordance between the tests was low for an APRI cut-off point >2 (kappa 0.213; 95% CI 0.094-0.332), as well as for cut-off points >1.5, >1 and >0.5 (kappa 0.213, 0.255, 0.257, respectively) CONCLUSION: Our results suggest that there is little concordance between APRI and liver biopsy for the diagnosis of cirrhosis in patients with ALD. It should therefore not be used as a single diagnostic method to determine cirrhosis.
有人提出，非侵入性方法可能会替代肝活检，用于诊断自身免疫性肝病（ALD）患者的组织损伤。本研究旨在确定 APRI 指数与肝活检在这些患者中诊断肝硬化的诊断性能和一致性程度。
在一组 ALD 患者中，根据 METAVIR 评分确定 APRI 指数和肝活检结果。通过卡帕统计评估 APRI 值>2 和 METAVIR 评分 F4 之间的 AUC 和一致性程度，作为肝硬化的标志物。
共纳入 70 例患者（年龄 51±13 岁）。最常见的自身免疫性肝病为原发性胆汁性肝硬化（PBC）（40%）、自身免疫性肝炎（AIH）（24.3%）和 AIH-PBC 重叠综合征（32.9%）。16 例患者（22.9%）经活检证实为肝硬化。15 例患者（21.4%）的 APRI 指数>2（肝硬化），但仅有 6 例符合这两个标准。APRI 的 AUC 为 0.77（95%CI 0.65-0.88）。APRI 截断值>2 时，两种检测方法的一致性程度较低（kappa 值为 0.213；95%CI 0.094-0.332），截断值>1.5、>1 和>0.5 时，一致性程度也较低（kappa 值分别为 0.213、0.255、0.257）。
我们的结果表明，APRI 与肝活检在诊断 ALD 患者肝硬化方面一致性较差。因此，它不应作为单一的诊断方法来确定肝硬化。
