Barreto Ana V M S, Domingues Ana L C, Diniz George T N, Cavalcanti Ana M S, Lopes Edmundo P, Montenegro Silvia M L, Morais Clarice N L
Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife-Pernambuco, 50670-420, Brasil.
Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife-Pernambuco, 50670-901, Brasil.
Trans R Soc Trop Med Hyg. 2022 Jan 19;116(1):19-25. doi: 10.1093/trstmh/trab040.
Periportal fibrosis (PPF) is the major pathological consequence of Schistosoma mansoni infection. The Coutinho index-the alkaline phosphatase (ALP) to platelet ratio ([ALP/upper limit of normality {ULN}]/platelet count [106/L] x 100)-was validated. Validation consisted of modest laboratory tests to predict advanced PPF.
A total of 378 individuals from an endemic area of Brazil with a previous history of the disease and/or a positive parasitological examination were evaluated. We used ultrasound examination as the gold standard for classification of the PPF pattern and measured the biological markers of the index.
Forty-one individuals (10.8%) without PPF, 291 (77%) with moderate PPF and 46 (12.2%) with advanced PPF, were identified. ALP and platelet count were used for the index. The cut-off point ≥0.228 predicted the presence of fibrosis with an area under the receiver operating characteristic curve (AUROC) of 0.56, sensitivity of 68.6% and specificity of 46.3%. There was an absence of PPF in 46.3% of individuals without fibrosis and the presence of PPF in 68.5% of cases with moderate and advanced ultrasound fibrosis. The identification of advanced fibrosis with a cut-off point ≥0.316 revealed an AUROC curve of 0.70, sensitivity of 67.4% and specificity of 68.3%, thus confirming the advanced phase in 65.2% of cases compared with ultrasound.
The Coutinho index was able to predict advanced PPF in most individuals. It is valid as a new tool, uses routine laboratory tests and therefore is more accessible for screening patients with a severe form of the disease in endemic areas.
门周纤维化（PPF）是曼氏血吸虫感染的主要病理后果。库蒂尼奥指数——碱性磷酸酶（ALP）与血小板比值（[ALP/正常上限{ULN}]/血小板计数[10⁶/L]×100）——得到了验证。验证包括适度的实验室检测以预测晚期PPF。
对来自巴西一个流行地区的378名曾患该病和/或寄生虫学检查呈阳性的个体进行了评估。我们将超声检查作为PPF模式分类的金标准，并测量了该指数的生物学标志物。
确定了41名（10.8%）无PPF的个体、291名（77%）有中度PPF的个体和46名（12.2%）有晚期PPF的个体。使用ALP和血小板计数来计算该指数。截断点≥0.228预测纤维化的存在，受试者操作特征曲线（AUROC）下面积为0.56，敏感性为68.6%，特异性为46.3%。46.3%无纤维化的个体未出现PPF，68.5%有中度和晚期超声纤维化的病例出现了PPF。截断点≥0.316识别晚期纤维化时，AUROC曲线为0.70，敏感性为67.4%，特异性为68.3%，因此与超声检查相比，在65.2%的病例中确认了晚期阶段。
库蒂尼奥指数能够在大多数个体中预测晚期PPF。它作为一种新工具是有效的，使用常规实验室检测，因此在流行地区筛查患有严重形式疾病的患者时更容易获得。
