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血清评分系统在预测慢性乙型肝炎所致肝纤维化中的应用:一项回顾性病例对照研究

The Use of Serum Scoring Systems in Predicting Liver Fibrosis Caused by Chronic Hepatitis B: A Retrospective Case-Control Study.

作者信息

Özgüler Müge, Durak Samet, Solmaz Özgen Arslan, Eser Karlıdağ Gülden, Gündağ Ömür, Kırık Yasemin, Tanır Büşra, Selim Kara Sümeyye

机构信息

Department of Infectious Diseases and Clinical Microbiology, Elazığ Fethi Sekin City Training, and Research Hospital, University of Health Sciences, 23280 Elazıg, Turkey.

Department of Pathology, Elazığ Fethi Sekin City Training, and Research Hospital, University of Health Science, 23280 Elazıg, Turkey.

出版信息

Medicina (Kaunas). 2025 Aug 20;61(8):1490. doi: 10.3390/medicina61081490.

Abstract

: Early diagnosis and monitoring of liver fibrosis in chronic hepatitis B are crucial for effective disease management and prognosis. Traditionally, percutaneous liver biopsy has been regarded as the gold standard for assessing the degree of fibrosis histopathologically. However, this method has several drawbacks. Consequently, non-invasive serum scoring systems are becoming increasingly preferred. These serum scoring systems have emerged as valuable non-invasive tools for predicting liver fibrosis in patients with chronic hepatitis B. Multiple serum-based scoring systems have been developed and validated for this purpose. The aim of this study is to determine the role of serum scoring systems in chronic hepatitis B, evaluate their performance, and analyze their correlation with liver biopsy results. : Patients diagnosed with Chronic Hepatitis B who underwent liver biopsy and were found to have liver fibrosis associated with chronic hepatitis B between August 2018 and July 2024 were included in this retrospective comparative case-control study and liver function tests, INR, alpha-fetoprotein levels, hemogram parameters, kidney function tests, and cholesterol levels at the time of biopsy were recorded. : The present study included a total of 249 patients, comprising 138 men (55.5%; mean age 42.1 years) and 111 women (44.5%; mean age 45.8 ± 13.5 years). The results of sixteen commonly used scoring systems in the current literature were evaluated for predicting fibrosis. According to ROC analysis, the most notable score identified was the KING score (0.775). The subsequent scores, in order, were AGAP (0.768), GUCI (0.748), FIB-4 (0.735), APRI (0.729), and S-INDEX (0.701). : Non-invasive methods offer potential advantages over liver biopsy. While these scoring systems demonstrate good accuracy in identifying advanced fibrosis and cirrhosis, their performance in detecting mild to moderate fibrosis is generally less reliable. They can function as preliminary screening tests to identify patients who may require further evaluation or to prioritize individuals for more advanced imaging studies or liver biopsy.

摘要

慢性乙型肝炎肝纤维化的早期诊断和监测对于有效的疾病管理和预后至关重要。传统上,经皮肝活检一直被视为通过组织病理学评估纤维化程度的金标准。然而,这种方法存在几个缺点。因此,非侵入性血清评分系统越来越受到青睐。这些血清评分系统已成为预测慢性乙型肝炎患者肝纤维化的有价值的非侵入性工具。为此,已经开发并验证了多种基于血清的评分系统。本研究的目的是确定血清评分系统在慢性乙型肝炎中的作用,评估其性能,并分析它们与肝活检结果的相关性。

本回顾性比较病例对照研究纳入了2018年8月至2024年7月期间被诊断为慢性乙型肝炎并接受肝活检且发现存在与慢性乙型肝炎相关的肝纤维化的患者,并记录了活检时的肝功能检查、国际标准化比值(INR)、甲胎蛋白水平、血常规参数、肾功能检查和胆固醇水平。

本研究共纳入249例患者,其中男性138例(55.5%;平均年龄42.1岁),女性111例(44.5%;平均年龄45.8±13.5岁)。对当前文献中十六种常用评分系统预测纤维化的结果进行了评估。根据受试者工作特征(ROC)分析,最显著的评分是KING评分(0.775)。随后依次是AGAP评分(0.768)、GUCI评分(0.748)、FIB-4评分(0.735)、APRI评分(0.729)和S-INDEX评分(0.701)。

非侵入性方法相对于肝活检具有潜在优势。虽然这些评分系统在识别晚期纤维化和肝硬化方面显示出良好的准确性,但其在检测轻度至中度纤维化方面的性能通常不太可靠。它们可作为初步筛查试验,以识别可能需要进一步评估的患者,或为更高级的影像学检查或肝活检确定优先顺序。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b42/12388333/5087f5205a5b/medicina-61-01490-g001.jpg

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