血清生物标志物预测酒精性肝病肝硬化：替代 ARFI-SW 弹性成像。

Serum biomarkers predictive of cirrhosis in alcoholic liver disease as an alternative to ARFI-SW elastography.

机构信息

Biochemistry Department, University of Medicine and Pharmacy "Carol Davilla", Bucharest, Romania.

出版信息

Eur Rev Med Pharmacol Sci. 2023 Jun;27(12):5590-5595. doi: 10.26355/eurrev_202306_32797.

DOI:10.26355/eurrev_202306_32797

PMID:37401296

Abstract

OBJECTIVE

Aspartate aminotransferase to platelet ratio index (APRI) and fibrosis 4 (FIB-4) index are noninvasive biomarkers that evaluate liver stiffness in patients with chronic viral hepatitis and are able to detect advanced hepatic fibrosis and cirrhosis. However, their usefulness in alcoholic liver disease (ALD), when compared with Acoustic Radiation Force Impulse- Shear Wave (ARFI-SW) elastography, is debatable.

PATIENTS AND METHODS

We sifted the files of all enrolled patients with ALD that were admitted to our Emergency hospital between January 2019 and December 2020. All patients had undergone ARFI-SW elastography, and APRI and FIB-4 scores were calculated. The performance of APRI and FIB-4 scores in the prediction of cirrhotic patients according to ARFI-SW elastography was evaluated.

RESULTS

In total, 120 patients with ALD were evaluated. All of them were male and Caucasian, with a mean age of 55.54±12.4 years. The mean ARFI-SW elastography score was 1.57±0.7 m/s, the median APRI score was 0.68 (0.1-11.6) and the median FIB-4 score was 1.8 (0.2-19.4). Stages of liver fibrosis according to ARFI-SW elastography were evaluated as F0-1 in 21 (10.5%), F2 in 35 (26%), F3 in 52 (17.5%), and F4 in 92 (46%) patients. Based on ARFI-SW elastography fibrosis stage classification, we estimated the optimal APRI and FIB-4 scores to predict the presence of liver cirrhosis (F4) by using ROC curve analysis and the Youden index. The optimal APRI score for F4 patients was calculated as >1.52 [area under the curve (AUC) 0.875, 95% CI 0.809-0.919; p<0.001], giving sensitivity (Se) 81.2%, specificity (Sp) 81.4%, positive predictive value (PPV) 76%, and negative predictive value (NPV) 86.1%. The optimal FIB-4 score for F4 patients was calculated as >2.77 (AUC 0.916, 95% CI 0.814-0.922; p<0.001), giving Se 83.8%, Sp 77%, 81.4 77%, and NPV 84.3%.

CONCLUSIONS

APRI and FIB-4 scores can be used as screening tools in ALD for predicting cirrhosis instead of ARFI-SW elastography measurement, which is neither widely available nor an affordable method. Additional prospective studies are required in the future to confirm this finding.

摘要

目的

天门冬氨酸氨基转移酶与血小板比值指数（APRI）和纤维化 4 指数（FIB-4）是评估慢性病毒性肝炎患者肝硬度的非侵入性生物标志物，能够检测到晚期肝纤维化和肝硬化。然而，在酒精性肝病（ALD）中，与声辐射力脉冲-剪切波（ARFI-SW）弹性成像相比，其有用性存在争议。

患者和方法

我们筛选了 2019 年 1 月至 2020 年 12 月期间在我院急诊科就诊的所有 ALD 患者的档案。所有患者均接受了 ARFI-SW 弹性成像检查，并计算了 APRI 和 FIB-4 评分。评估 APRI 和 FIB-4 评分根据 ARFI-SW 弹性成像预测肝硬化患者的表现。

结果

共有 120 例 ALD 患者接受了评估。他们均为男性，白种人，平均年龄 55.54±12.4 岁。平均 ARFI-SW 弹性成像评分 1.57±0.7 m/s，中位数 APRI 评分 0.68（0.1-11.6），中位数 FIB-4 评分 1.8（0.2-19.4）。根据 ARFI-SW 弹性成像评估，肝纤维化分期为 F0-1 期 21 例（10.5%），F2 期 35 例（26%），F3 期 52 例（17.5%），F4 期 92 例（46%）。基于 ARFI-SW 弹性成像纤维化分期分类，我们使用 ROC 曲线分析和约登指数估算了 APRI 和 FIB-4 评分来预测肝硬化（F4）的最佳临界值。预测 F4 患者的最佳 APRI 评分计算为>1.52 [曲线下面积（AUC）0.875，95%CI 0.809-0.919；p<0.001]，其灵敏度（Se）为 81.2%，特异性（Sp）为 81.4%，阳性预测值（PPV）为 76%，阴性预测值（NPV）为 86.1%。预测 F4 患者的最佳 FIB-4 评分计算为>2.77（AUC 0.916，95%CI 0.814-0.922；p<0.001），其 Se 为 83.8%，Sp 为 77%，PPV 为 81.4%，NPV 为 77%。