Wang Zeyu, Zhou Yonghe, Yu Pengzhi, Liu Yonggang, Mei Mei, Bian Zhuo, Shao Wei, Lv Jinxia, Li Xin, Lu Wei, Xu Liang
Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China.
Ultrasound department, Tianjin Second People's Hospital, Tianjin, 300192, People's Republic of China.
Int J Gen Med. 2022 May 25;15:5159-5171. doi: 10.2147/IJGM.S364216. eCollection 2022.
At present, there is a lack of cheap, effective and convenient detection methods for hepatitis B-related liver fibrosis, especially in the developing area.
To evaluate the non-invasive methods for the significant and advanced fibrosis stage in chronic hepatitis B virus (HBV) patients in basic hospitals and to assess their diagnostic utility.
The study included 436 consecutive naive HBV individuals who had their livers biopsied. They were examined in one week using aspartate aminotransferase-to-aspartate aminotransferase ratio (AAR), age-platelet index (API), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4), Forns, gamma-glutamyl transpeptidase-to-platelet ratio (GPR), S-index and transient elastography (TE). Scheuer scoring system was used to determine the histologic fibrosis grades (S0-S4). The diagnostic effectiveness was assessed using AUROCs and the DeLong test, both of which were based on statistical comparisons.
For both substantial (≧S2) and advanced (≧S3) fibrosis phases, TE had good diagnostic performance in determining the hepatic fibrosis. Similar diagnostic performance was shown with Forns and S-index when it came to detecting fibrosis stages lower than S3. One model's diagnostic value was not significantly improved by combining serum models. Correlation coefficients between clinical features and fibrosis phases were greatest for Forns ( = 0.397), S-index ( = 0.382) and TE ( = 0.535) when compared to other variables.
This investigation showed that Forns and S-index may be helpful strategies for detecting advanced fibrosis in HBV patients admitted to community hospitals.
目前，对于乙型肝炎相关肝纤维化，缺乏廉价、有效且便捷的检测方法，尤其是在发展中地区。
评估基层医院慢性乙型肝炎病毒（HBV）患者显著和晚期纤维化阶段的非侵入性方法，并评估其诊断效用。
该研究纳入了436例连续的初治HBV个体，这些个体均接受了肝脏活检。在一周内，使用天冬氨酸转氨酶与天冬氨酸转氨酶比值（AAR）、年龄-血小板指数（API）、天冬氨酸转氨酶与血小板比值指数（APRI）、纤维化-4（FIB-4）、Forns指数、γ-谷氨酰转肽酶与血小板比值（GPR）、S指数和瞬时弹性成像（TE）对他们进行检查。采用Scheuer评分系统确定组织学纤维化分级（S0-S4）。使用基于统计比较的受试者工作特征曲线下面积（AUROCs）和DeLong检验评估诊断有效性。
对于显著（≧S2）和晚期（≧S3）纤维化阶段，TE在确定肝纤维化方面具有良好的诊断性能。在检测低于S3的纤维化阶段时，Forns指数和S指数显示出类似的诊断性能。血清模型联合使用并未显著提高一种模型的诊断价值。与其他变量相比，Forns指数（=0.397）、S指数（=0.382）和TE（=0.535）与临床特征和纤维化阶段之间的相关系数最大。
本研究表明，Forns指数和S指数可能是检测社区医院收治的HBV患者晚期纤维化的有用策略。
