Ong Sim Yee, Khoo Tiffany, Nicoll Amanda J, Gurrin Lyle, Worland Thomas, Pateria Puraskar, Ramm Louise E, Testro Adam, Anderson Gregory J, Skoien Richard, Powell Lawrie W, Ramm Grant A, Olynyk John K, Delatycki Martin B
Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
The University of Melbourne, Melbourne, VIC, Australia.
Sci Rep. 2021 Jul 19;11(1):14654. doi: 10.1038/s41598-021-94083-x.
Aspartate aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 Index (Fib4) have been validated against liver biopsy for detecting advanced hepatic fibrosis in HFE hemochromatosis. We determined the diagnostic utility for advanced hepatic fibrosis of Hepascore and transient elastography compared with APRI and Fib4 in 134 newly diagnosed HFE hemochromatosis subjects with serum ferritin levels > 300 µg/L using area under the receiver operator characteristic curve (AUROC) analysis and APRI- (> 0.44) or Fib4- (> 1.1) cut-offs for AHF, or a combination of both. Compared with APRI, Hepascore demonstrated an AUROC for advanced fibrosis of 0.69 (95% CI 0.56-0.83; sensitivity = 69%, specificity = 65%; P = 0.01) at a cut-off of 0.22. Using a combination of APRI and Fib4, the AUROC for Hepascore for advanced fibrosis was 0.70 (95% CI 0.54-0.86, P = 0.02). Hepascore was not diagnostic for detection of advanced fibrosis using the Fib4 cut-off. Elastography was not diagnostic using either APRI or Fib4 cut-offs. Hepascore and elastography detected significantly fewer true positive or true negative cases of advanced fibrosis compared with APRI and Fib4, except in subjects with serum ferritin levels > 1000 µg/L. In comparison with APRI or Fib4, Hepascore or elastography may underdiagnose advanced fibrosis in HFE Hemochromatosis, except in individuals with serum ferritin levels > 1000 µg/L.
天冬氨酸转氨酶与血小板比值指数（APRI）和纤维化-4指数（Fib4）已通过肝活检验证，用于检测HFE血色素沉着症中的晚期肝纤维化。我们使用受试者工作特征曲线下面积（AUROC）分析以及APRI（>0.44）或Fib4（>1.1）的AHF临界值或两者结合，在134例新诊断的血清铁蛋白水平>300μg/L的HFE血色素沉着症患者中，确定了Hepascore和瞬时弹性成像与APRI和Fib4相比对晚期肝纤维化的诊断效用。与APRI相比，Hepascore在临界值为0.22时，晚期纤维化的AUROC为0.69（95%CI 0.56-0.83；敏感性=69%，特异性=65%；P=0.01）。使用APRI和Fib4的组合，Hepascore对晚期纤维化的AUROC为0.70（95%CI 0.54-0.86，P=0.02）。使用Fib4临界值时，Hepascore对晚期纤维化无诊断价值。弹性成像使用APRI或Fib4临界值时均无诊断价值。与APRI和Fib4相比，Hepascore和弹性成像检测到的晚期纤维化真阳性或真阴性病例明显较少，血清铁蛋白水平>1000μg/L的患者除外。与APRI或Fib4相比，Hepascore或弹性成像可能会漏诊HFE血色素沉着症中的晚期纤维化，血清铁蛋白水平>1000μg/L的个体除外。
