Ghachem Ikbel, Hamzaoui Lamine, Bachali Asma, Rhimi Chayma, Medhioub Mouna, Mahmoudi Moufida, Khsiba Amal, Azouz Mohamed Msaddak
Medical analysis laboratory, Mohamed Taher Maamouri Hospital, Nabeul. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis,Tunisia.
Gastroenterology Department, Mohamed Taher Maamouri Hospital, Nabeul. Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis,Tunisia.
Tunis Med. 2024 Oct 5;102(10):715-721. doi: 10.62438/tunismed.v102i10.5091.
Several non-invasive tests (NIT) have been reported for predicting liver fibrosis to avoid percutaneous liver biopsy (PLB).
To evaluate the performance of NIT in Tunisian patients with chronic hepatitis B (CHB).
We calculated the ASAT/platelet ratio index (APRI), GGT-to-platelet ratio (GPR), Fibrosis-4 score (FIB-4), and RDW/platelet ratio (RPR). The accuracy of NIT was compared with the Metavir score for the detection of liver fibrosis stage using the area under the ROC curves (AUROC).
Seventy-seven CHB patients were included. For predicting significant fibrosis, the AUROC of GPR (0.81; CI95% [0.68-0.93]; P < 0.001) was significantly higher than that of RPR (0.67; CI95% [0.52-0.82]; P = 0.03) and FIB-4 (0.746; CI95% [0.61-0.88]; P = 0.002), but was similar to APRI (0.88; CI95% [0.79-0.97]; P < 0.001). For advanced fibrosis, the AUROC of GPR (0.93; CI95% [0.84-1]; P < 0.001) was higher than that of RPR (0.83; CI95% [0.69-0.97]; P < 0.001) and FIB-4 (0.88; CI95% [0.76-0.99]; P < 0.001), but similar to APRI (0.93; CI95% [0.87-0.99]; P < 0.001). For predicting cirrhosis, the AUROC of GPR (0.98; CI95% [0.95-1]; P < 0.001) was higher than that of APRI (0.95; CI95% [0.90-1]; P = 0.02), similar to RPR (0.99; CI95% [0.98-1]; P < 0.001) but lower than that of FIB-4 (1; CI95% [1-1]; P < 0.001). In multivariate analysis, APRI (OR = 3.78; P = 0.002) and FIB-4 (OR = 2.65; P = 0.01) were independent predictors of significant fibrosis. GPR was the only independent predictor of advanced fibrosis (OR = 4.64; P = 0.001) and FIB-4 was the independent predictor of cirrhosis (OR = 2.85; P < 0.001).
GPR does not demonstrate significant advantages over APRI, FIB-4, and RPR in identifying liver fibrosis in patients with chronic hepatitis B (CHB).
已有多项非侵入性检测（NIT）用于预测肝纤维化，以避免经皮肝穿刺活检（PLB）。
评估NIT在突尼斯慢性乙型肝炎（CHB）患者中的性能。
我们计算了天冬氨酸转氨酶/血小板比率指数（APRI）、谷氨酰转肽酶/血小板比率（GPR）、纤维化-4评分（FIB-4）和红细胞分布宽度/血小板比率（RPR）。使用ROC曲线下面积（AUROC）将NIT的准确性与用于检测肝纤维化分期的梅塔维评分进行比较。
纳入了77例CHB患者。对于预测显著纤维化，GPR的AUROC（0.81；95%CI[0.68-0.93]；P<0.001）显著高于RPR（0.67；95%CI[0.52-0.82]；P = 0.03）和FIB-4（0.746；95%CI[0.61-0.88]；P = 0.002），但与APRI（0.88；95%CI[0.79-0.97]；P<0.001）相似。对于晚期纤维化，GPR的AUROC（0.93；95%CI[0.84-1]；P<0.001）高于RPR（0.83；95%CI[0.69-0.97]；P<0.001）和FIB-4（0.88；95%CI[0.76-0.99]；P<0.001），但与APRI（0.93；95%CI[0.87-0.99]；P<0.001）相似。对于预测肝硬化，GPR的AUROC（0.98；95%CI[0.95-1]；P<0.001）高于APRI（0.95；95%CI[0.90-1]；P = 0.02），与RPR（0.99；95%CI[0.98-1]；P<0.001）相似，但低于FIB-4（1；95%CI[1-1]；P<0.001）。在多变量分析中，APRI（OR = 3.
