增强型肝纤维化评分：它对评估慢性丙型肝炎感染中的纤维化严重程度有用吗？
Enhanced Liver Fibrosis Score: Is It Useful for Evaluation of Fibrosis Severity in Chronic Hepatitis C Infection?
作者信息
Kumar Manish, George Roshan, Vaithiyam Venkatesh, Sakhuja Puja, Dahale Amol S, Dayal Aman, Dalal Ashok, Sonika Ujjwal, Sachdeva Sanjeev, Kumar Ajay
机构信息
Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND.
Department of Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND.
出版信息
Cureus. 2022 Jan 12;14(1):e21168. doi: 10.7759/cureus.21168. eCollection 2022 Jan.
INTRODUCTION
The assessment of liver fibrosis is important in patients with chronic hepatitis C (CHC). In recent years, non-invasive tests like enhanced liver fibrosis (ELF) have been developed as an alternative to liver biopsy for estimating the severity of liver fibrosis. Therefore, we aimed to assess whether the ELF score can be used for fibrosis severity estimation using liver biopsy as the gold standard.
MATERIALS AND METHODS
Forty-nine patients with CHC were enrolled in this study. Liver biopsy, ELF assessment, and transient elastography (TE) were performed in all patients, and severity of fibrosis on histopathology was assessed by meta-analysis of histological data in viral hepatitis (METAVIR) score. In addition, the diagnostic performance of ELF was evaluated by receiver operator characteristic curve (ROC) analyses, and liver biopsy histopathology was taken as the gold standard for the severity of liver fibrosis.
RESULTS
The area under receiver operator characteristic curve (AUROC) for significant fibrosis of ELF score was 0.64 (95% confidence interval {CI}, 0.48-0.79) and of TE was 0.85 (95% CI, 0.73-0.96). The AUROC for advance fibrosis of ELF was 0.77 (95% CI, 0.57-0.97) and TE was 0.98 (95% CI, 0.94-1.0). The calculated cut-offs of ELF overestimated fibrosis in 53.06% (26/49) of patients and underestimated fibrosis in 6.12% (3/49) patients. AUROC of TE was significantly better than ELF for diagnosis of significant fibrosis (p=0.004) and advanced fibrosis (p=0.034).
CONCLUSION
The ELF score can be used for estimating the severity of fibrosis but it is inferior to TE in estimating liver fibrosis severity.
引言
肝纤维化评估对于慢性丙型肝炎（CHC）患者至关重要。近年来，诸如增强肝纤维化（ELF）等非侵入性检测方法已被开发出来，可替代肝活检用于评估肝纤维化的严重程度。因此，我们旨在以肝活检作为金标准，评估ELF评分是否可用于肝纤维化严重程度的评估。
材料与方法
本研究纳入了49例CHC患者。所有患者均接受了肝活检、ELF评估和瞬时弹性成像（TE）检查，并通过病毒性肝炎组织学数据的荟萃分析（METAVIR）评分评估组织病理学上的纤维化严重程度。此外，通过受试者操作特征曲线（ROC）分析评估ELF的诊断性能，并将肝活检组织病理学作为肝纤维化严重程度的金标准。
结果
ELF评分诊断显著纤维化的受试者操作特征曲线下面积（AUROC）为0.64（95%置信区间{CI}，0.48 - 0.79），TE的AUROC为0.85（95% CI，0.73 - 0.96）。ELF诊断进展性纤维化的AUROC为0.77（95% CI，0.57 - 0.97），TE的AUROC为0.98（95% CI，0.94 - 1.0）。计算得出的ELF临界值在53.06%（26/49）的患者中高估了纤维化程度，在6.12%（3/49）的患者中低估了纤维化程度。在诊断显著纤维化（p = 0.004）和进展性纤维化（p = 0.034）方面，TE的AUROC显著优于ELF。
结论
ELF评分可用于评估纤维化严重程度，但在评估肝纤维化严重程度方面不如TE。
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