Fan Rong, Li Guanlin, Yu Ning, Chang Xiujuan, Arshad Tamoore, Liu Wen-Yue, Chen Yan, Wong Grace Lai-Hung, Jiang Yiyue, Liang Xieer, Chen Yongpeng, Jin Xiao-Zhi, Dong Zheng, Leung Howard Ho-Wai, Wang Xiao-Dong, Zeng Zhen, Yip Terry Cheuk-Fung, Xie Qing, Tan Deming, You Shaoli, Ji Dong, Zhao Jun, Sanyal Arun J, Sun Jian, Zheng Ming-Hua, Wong Vincent Wai-Sun, Yang Yongping, Hou Jinlin
Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Clinical Research Center for Viral Hepatitis, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Medical Data Analytics Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
Clin Gastroenterol Hepatol. 2023 Nov;21(12):3070-3079.e13. doi: 10.1016/j.cgh.2023.03.005. Epub 2023 Mar 17.
BACKGROUND & AIMS: The changes in liver stiffness measurement (LSM) are unreliable to estimate regression of fibrosis during antiviral treatment for chronic hepatitis B (CHB) patients. The age-male-albumin-bilirubin-platelets score (aMAP), as an accurate hepatocellular carcinoma risk score, may reflect the liver fibrosis stage. Here, we aimed to evaluate the performance of aMAP for diagnosing liver fibrosis in CHB patients with or without treatment.
A total of 2053 patients from 2 real-world cohorts and 2 multicentric randomized controlled trials in China were enrolled, among which 2053 CHB patients were included in the cross-sectional analysis, and 889 CHB patients with paired liver biopsies before and after 72 or 104 weeks of treatment were included in the longitudinal analysis.
In the cross-sectional analysis, the areas under the receiver operating characteristic curve of aMAP in diagnosing cirrhosis and advanced fibrosis were 0.788 and 0.757, which were comparable with or significantly higher than those of the fibrosis index based on 4 factors and the aspartate aminotransferase-platelet ratio. The stepwise approach using aMAP and LSM further improved performance in detecting cirrhosis and advanced fibrosis with the smallest uncertainty area (29.7% and 46.2%, respectively) and high accuracy (82.3% and 79.8%, respectively). In the longitudinal analysis, we established a novel model (aMAP-LSM model) by calculating aMAP and LSM results before and after treatment, which had satisfactory performance in diagnosing cirrhosis and advanced fibrosis after treatment (area under the receiver operating characteristic curve, 0.839 and 0.840, respectively), especially for those with a significant decrease in LSM after treatment (vs LSM alone, 0.828 vs 0.748; P < .001 [cirrhosis]; 0.825 vs 0.750; P < .001 [advanced fibrosis]).
The aMAP score is a promising noninvasive tool for diagnosing fibrosis in CHB patients. The aMAP-LSM model could accurately estimate fibrosis stage for treated CHB patients.
对于慢性乙型肝炎（CHB）患者，在抗病毒治疗期间，肝脏硬度测量（LSM）的变化对于评估纤维化消退情况并不可靠。年龄-男性-白蛋白-胆红素-血小板评分（aMAP）作为一种准确的肝细胞癌风险评分，可能反映肝脏纤维化阶段。在此，我们旨在评估aMAP在诊断接受或未接受治疗的CHB患者肝纤维化方面的性能。
纳入了来自中国2个真实世界队列和2项多中心随机对照试验的总共2053例患者，其中2053例CHB患者纳入横断面分析，889例在治疗72周或104周前后进行了配对肝活检的CHB患者纳入纵向分析。
在横断面分析中，aMAP诊断肝硬化和进展性纤维化的受试者操作特征曲线下面积分别为0.788和0.757，与基于4项因素的纤维化指数和天冬氨酸转氨酶-血小板比值相当或显著更高。使用aMAP和LSM的逐步方法在检测肝硬化和进展性纤维化方面进一步提高了性能，不确定性区域最小（分别为29.7%和46.2%）且准确性高（分别为82.3%和79.8%）。在纵向分析中，我们通过计算治疗前后的aMAP和LSM结果建立了一种新模型（aMAP-LSM模型），该模型在诊断治疗后的肝硬化和进展性纤维化方面具有令人满意的性能（受试者操作特征曲线下面积分别为0.839和0.840），特别是对于治疗后LSM显著降低的患者（与单独使用LSM相比，肝硬化：0.828对0.748；P <.001；进展性纤维化：0.825对0.750；P <.001）。
aMAP评分是诊断CHB患者纤维化的一种有前景的非侵入性工具。aMAP-LSM模型可以准确估计接受治疗的CHB患者的纤维化阶段。
