甲胎蛋白水平，肝脏纤维化状况的生物标志物：连续619例慢

StephenW

Alpha-fetoprotein level as a biomarker of liver fibrosis status: a cross-sectional study of 619 consecutive patients with chronic hepatitis B


Hepatitis B virus (HBV) infection is a serious public health problem worldwide. This study aimed to investigate the relationship between serum alpha-fetoprotein (AFP) levels and pathological stages of liver biopsy in patients with chronic hepatitis B (CHB).

Methods: The study included 619 patients who were diagnosed with CHB from March 2005 to December 2011.

AFP levels were measured by electrochemiluminescence. Liver biopsy samples were classified into five levels of inflammation (G) and fibrosis (S) stages, according to the Chinese guidelines for prevention and treatment of viral hepatitis.

Two multivariable ordinal regression models were performed to determine associations between AFP, GGT, and APRI (AST/PLT ratio) and stages of inflammation and fibrosis.

Results: Significant positive and moderate correlations were shown between AFP levels and inflammation stages and between AFP levels and fibrosis stages (rho = 0.436 and 0.404, p <0.001). Median values of AFP at liver fibrosis stages S0-1, S2, S3, and S4 were 3.0, 3.4, 5.4, and 11.3 ng/ml, respectively, and median APRI (AST/PLT ratio) was 0.41.

Receiver operating characteristic (ROC) curve analyses revealed that the areas under the curves (AUCs) were 0.685, 0.727, and 0.755 (all p <0.001) for judging inflammation stages of G >= 2, G >= 3, G = 4 by AFP; and 0.691, 0.717, and 0.718 (all p <0.001) for judging fibrosis stages of S >= 2, S >= 3, and S = 4 by AFP. APRI levels showed significant positive and moderate correlations with inflammation stages (rho = 0.445, p <0.001).

AST, GGT, and APRI levels showed significant positive but very weak to weak correlations with fibrosis stages (rho = 0.137, 0.237, 0.281, p <0.001).

Conclusions: Serum AFP levels increased as pathological levels of inflammation and fibrosis increased in CHB patients. Our data showed the clinical significance of serum AFP levels in diagnosing liver inflammation and fibrosis.

Assessment of liver pathology may be improved by creating a predictive mathematical model by which AFP levels with other biomarkers.

Author: Yu-rui LiuBin-bin LinDa-wu ZengYue-yong ZhuJing ChenQi ZhengJing DongJia-ji Jiang
Credits/Source: BMC Gastroenterology 2014, 14:145

StephenW

甲胎蛋白水平，肝脏纤维化状况的生物标志物：连续619例慢性乙型肝炎患者的横断面研究


乙型肝炎病毒（HBV）感染是全球严重的公共卫生问题。本研究旨在探讨慢性乙型肝炎（CHB）患者血清甲胎蛋白（AFP）水平与肝活检病理分期之间的关系。

方法：本研究包括谁被诊断为慢性乙型肝炎从2005年3月至2011年12月619例。

法新社水平通过电化学发光检测。肝活检标本分为五个等级炎症（G）和纤维化（S）阶段，根据中国准则的预防和治疗病毒性肝炎。

两个多变量有序回归模型，以确定AFP，GGT和APRI（AST/ PLT比），炎症和纤维化分期之间的关联。

结果：显着的积极和适度的相关性AFP水平和炎症阶段的AFP水平与纤维化分期与显示（RHO=0.436和0.404，P <0.001）。 AFP在肝纤维化的阶段S0-1，S2，S3和S4中位值分别为3.0，3.4，5.4，和11.3纳克/毫升，分别与中值APRI（AST/ PLT比）为0.41。

受试者工作特征（ROC）曲线分析显示，根据曲线（曲线下面积）的区域<判断的G炎症阶段（由0.001= 2，G>=3，G =4分别为0.685，0.727，0.755和所有P）>法新社;和0.691，0.717，0.718和（均P<0.001），判断的S纤维化分期>=2，S>= 3，S =4法新社。 APRI水平与炎症反应阶段（RHO=0.445，P <0.001）显著积极稳健的相关性。

AST，GGT和APRI水平呈显著积极的，但很虚弱与纤维化分期（RHO=0.137，0.237，0.281，P <0.001），弱相关性。

结论：血清AFP水平随炎症和纤维化慢性乙型肝炎患者增加的病理级别。我们的数据显示，血清AFP水平在诊断肝组织炎症和纤维化的临床意义。

肝脏病理评估可能通过创建由AFP水平与其他生物标志物预测的数学模型加以改进。

作者：于瑞留斌彬琳达武ZengYue勇朱经理陈旗郑经理东佳骥江
币/资料来源：BMC胃肠病学2014年，14：145

重肝过后

我的afp只有1.x ng/ml，可是肝却是硬邦邦了……
好多认识的硬化战友，afp也挺低的

StephenW

回复 重肝过后 的帖子

谢谢. 这给你:

Long-term changes of liver stiffness values assessed using transient elastography in patients with chronic hepatitis B receiving entecavir

    Mi Na Kim1,2,
    Seung Up Kim1,2,3,*,
    Beom Kyung Kim1,2,3,
    Jun Yong Park1,2,3,
    Do Young Kim1,2,3,
    Sang Hoon Ahn1,2,3,4 and
    Kwang-Hyub Han1,2,3,4

Article first published online: 24 NOV 2013

DOI: 10.1111/liv.12377

© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Issue
Liver International

Volume 34, Issue 8, pages 1216–1223, September 2014

Additional Information(Show All)


Abstract
Background & Aims

Liver stiffness (LS) measurement using transient elastography allows for accurate evaluation of liver fibrosis in patients with chronic liver disease. We aimed to investigate the influence of antiviral treatment using entecavir (ETV) on LS values in patients with chronic hepatitis B (CHB).
Methods

121 patients with CHB who completed a 3-year ETV treatment were recruited. LS values were measured before starting ETV (baseline) and after the completion of the 3-year treatment. A significant decline in the LS value was defined as a ≥30% drop from the baseline.
Results

The median baseline LS value of the patients was 14.3 kPa. However, it decreased significantly to 7.3 kPa after 3-year ETV treatment (P < 0.001). A higher baseline LS value was the single independent predictor of a significant decline in LS value on multivariate analysis (P<0.001; hazard ratio [HR], 1.155; 95% confidence interval [CI], 1.073–1.243). Using an optimal cutoff baseline LS value of 11.5 kPa (area under receiver operating characteristic curve, 0.781; 95% CI, 0.698–0.863, P < 0.001; sensitivity 75.6%; specificity, 62.8%), patients with baseline LS values of ≥11.5 kPa had a greater probability of experiencing a significant decline in the LS value than those with baseline LS values of <11.5 kPa (P < 0.001; HR, 5.240; 95% CI, 2.340–11.732).
Conclusions

In patients with CHB, LS values were decreased significantly after a 3-year ETV treatment. A higher baseline LS value was the single independent predictor of a significant decline in the LS value.


肝脏硬度值的长期变化采用瞬时弹性成像在慢性乙型肝炎接受恩替卡韦评估

    宓嗯啊Kim1,2，
    升向上Kim1,2,3，*，
    范庆Kim1,2,3，
    君永Park1,2,3，
    难道年轻Kim1,2,3，
    桑勋Ahn1,2,3,4和
    刘广Hyub Han1,2,3,4

文章首次发表时间：2013年11月24日

DOI：10.1111/ liv.12377

©2013约翰·威利父子A / S。由John Wiley＆Sons出版公司

问题
国际肝病

第34卷，第8期，页1216至1223年，2014年9月

其他信息（显示所有）


摘要
背景与目的

采用瞬时弹性成像肝脏硬度（LS）的测量允许的肝纤维化患者慢性肝病准确的评价。我们的目的是探讨使用抗病毒药物恩替卡韦治疗的（ETV）的LS值在慢性乙型肝炎（CHB）的影响。
方法

121例慢性乙型肝炎患者谁完成了3年的ETV治疗进行招募。开始ETV（基线）前，完成3年的治疗后的LS值进行了测定。在LS值A显著衰退被定义为下降从基线≥30％。
结果

患者的平均基线的LS值为14.3千帕。然而，它显著到7.3千帕3年ETV治疗（P <0.001）减少。较高的基线的LS值的LS价值显著下降的多变量分析单个独立预测因子（p <0.001;风险比[HR]为1.155;95％信心区间[CI]为1.073-1.243）。采用11.5千帕的最佳临界基线的LS值（面积在受试者工作特征曲线，0.781，95％CI，0.698-0.863，P <0.001;敏感性75.6％，特异性62.8％），患者≥11.5基线的LS值人民军的经历在LS价值显著跌幅比与<11.5千帕基线的LS值较大的概率（P<0.001; HR，5.240; 95％CI为2.340-11.732）。
结论

在慢性乙肝患者，LS值分别为3年恩替卡韦治疗后显著下降。较高的基线的LS值在LS价值显著下降的一个独立预测因子。

重肝过后

回复 StephenW 的帖子

谢谢您的鼓励，我两年前做fibroscan是40kPa以上……

tlyuhq

英文看不懂，译成中文后感觉表述不合我们日常用语。

我想问问楼主，甲胎蛋白水平和肝纤维化之间怎么存在必然联系呢？事实上它们没有必然联系吧？3楼说的确实是事实呀！

理论上，fibroscan扫描数值>=12KPa即为肝硬化；<12KPa为肝纤维化；<7.5KPa为肝组织正常。请问这种判断是否科学？

StephenW

回复 tlyuhq 的帖子

甲胎蛋白水平和肝纤维化之间怎么存在必然联系呢？我没看全文，我不知道. 论文摘要
说AFP水平和纤维化水平有相关性(correlation).
事实上它们没有必然联系吧？3楼说的确实是事实呀！相关性可能是非常弱的.
理论上，fibroscan扫描数值>=12KPa即为肝硬化；<12KPa为肝纤维化；<7.5KPa为肝组织正常。请问这种判断是否科学？我认为是科学, 通过比较肝活检结果证实, 但就像肝活检，不是100％准确.