血清生物标志物作为慢性丙型肝炎肝纤维化分期中替代振动控制瞬时弹性成像的方法。

Serum biomarkers as an alternative to vibration controlled transient elastography in liver fibrosis staging in chronic hepatitis C.

机构信息

Department of Gastroenterology, T.N.M.C and B.Y.L Nair Charitable Hospital, Mumbai, India.

Department of Medicine, Santosh Medical College, Ghaziabad, India.

出版信息

Acta Gastroenterol Belg. 2021 Jan-Mar;84(1):43-50. doi: 10.51821/84.1.776.

DOI:10.51821/84.1.776

PMID:33639692

Abstract

BACKGROUND

Assessment of liver disease severity in chronic Hepatitis C (CHC) is essential both in pretreatment and posttreatment period. We assessed the impact of direct-acting antiviral therapy on liver stiffness regression measured by Vibration Controlled Transient Elastography (VCTE) in patients with CHC and evaluated the diagnostic performance of the APRI and FIB-4 scores compared to VCTE in detecting advanced fibrosis and cirrhosis (F3/F4).

METHODOLOGY

Retrospective analysis of consecutive patients with CHC who underwent VCTE before and after DAA therapy was done. APRI and FIB-4 scores were compared to VCTE.

RESULTS

88 (56.78%) patients-12 (F3) and 76 (F4) according to VCTE, had advanced fibrosis pretreatment, which reduced to 69 (44.52%) - 10 (F3) and 59 (F4) after 12 weeks DAA therapy. Significant reduction in VCTE value from 14.08 ± 9.05 KPa to 11.84 ± 8.31 KPa (p=0.002) was noted. There is significant reduction in APRI, FIB-4 and GUCI score posttreatment which was not the case with Lok score and Bonacini score. Before therapy, FIB-4 outperformed others to predict advanced fibrosis with score >2.13 (AUC 0.93), having sensitivity 76%, specificity 96% and accuracy 86%. However posttreatment, APRI and GUCI score performed best to predict F3/F4 fibrosis with score >0.63 (AUC 0.97) and >0.64 (AUC 0.96), having sensitivity, specificity and accuracy of 85%, 96.6% and 92% ; 85%, 6.6% and 92% respectively.

CONCLUSION

Before therapy, FIB-4 had the best accuracy in predicting advanced fibrosis whereas APRI and GUCI score were the best indices post-treatment.

摘要

背景

在慢性丙型肝炎（CHC）的治疗前和治疗后，评估肝脏疾病的严重程度是至关重要的。我们评估了直接作用抗病毒治疗对 CHC 患者通过振动控制瞬态弹性成像（VCTE）测量的肝硬度消退的影响，并评估了 APRI 和 FIB-4 评分与 VCTE 相比在检测晚期纤维化和肝硬化（F3/F4）方面的诊断性能。

方法

对接受 DAA 治疗前后进行 VCTE 的连续 CHC 患者进行回顾性分析。比较 APRI 和 FIB-4 评分与 VCTE。

结果

88 例（56.78%）患者-12 例（F3）和 76 例（F4）根据 VCTE 检测到治疗前有晚期纤维化，在 12 周 DAA 治疗后减少到 69 例（F3）和 59 例（F4）。VCTE 值从 14.08±9.05kPa 显著降低到 11.84±8.31kPa（p=0.002）。治疗后 APRI、FIB-4 和 GUCI 评分显著降低，但 Lok 评分和 Bonacini 评分则不然。治疗前，FIB-4 以评分>2.13（AUC 0.93）预测晚期纤维化的效果优于其他指标，具有 76%的敏感性、96%的特异性和 86%的准确性。然而，治疗后，APRI 和 GUCI 评分以评分>0.63（AUC 0.97）和>0.64（AUC 0.96）预测 F3/F4 纤维化的效果最佳，其敏感性、特异性和准确性分别为 85%、96.6%和 92%；85%、6.6%和 92%。