Clin Microbiol Infect. 2018 Jun 12. pii: S1198-743X(18)30461-0. doi: 10.1016/j.cmi.2018.06.002. [Epub ahead of print]
Gamma-glutamyl transpeptidase to cholinesterase and platelet ratio in predicting significant liver fibrosis and cirrhosis of chronic hepatitis B.
Liu D1, Li J2, Lu W1, Wang Y1, Zhou X1, Huang D1, Li X1, Ding R1, Zhang Z3.
Author information
1
Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
2
Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China; Department of Infectology, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.
3
Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China; Department of Infectology, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China. Electronic address: [email protected].
Abstract
OBJECTIVE:
To evaluate the performance of a new mathematical model gamma- glutamyl transpeptidase to cholinesterase and platelet ratio (GCPR) versus gamma- glutamyl transpeptidase to platelet ratio (GPR) in predicting significant fibrosis and cirrhosis of chronic hepatitis B (CHB).
METHODS:
A complete cohort of 2343 patients was divided into early and late cohort depending on the time of liver biopsy. With reference to the Scheuer standard, liver pathological stage ≥S2 and ≥S4 were defined as significant fibrosis and cirrhosis, respectively. ROC curve was used to evaluate the performance of investigated models.
RESULTS:
In early cohort，the areas under ROC curves (AUROCs) of GCPR in predicting significant fibrosis of HBeAg-positive and HBeAg-negative patients (0.782 and 0.775) were both significantly greater than those of GPR (0.748 and 0.747) (Z＝8.198 and Z＝6.023, both P<0.0001); the AUROCs of GCPR in predicting cirrhosis of HBeAg-positive and HBeAg-negative patients (0.842 and 0.861) were both significantly greater than those of GPR (0.802 and 0.823) (Z＝6.686 and Z＝6.116, both P<0.0001). In early, late and complete cohort, using a single cutoff of GPCR>0.080, the specificities of GCPR in predicting significant fibrosis of HBeAg-positive patients were 83.3%, 88.2% and 85.0%, and of HBeAg-negative patients were 87.6%, 87.4% and 87.6%, respectively; and the sensitivities of GCPR in predicting cirrhosis of HBeAg-positive patients were 81.9%, 88.7% and 84.2%, and of HBeAg-negative patients were 83.1%,82.1% and 82.7%, respectively.
CONCLUSIONS:
GCPR has higher performance than GPR in predicting significant fibrosis and cirrhosis of CHB.
GPR的公式 = (GGT (U/L)/ULN of GGT)/PLT count (10**9/ L) ×100
GPR的截止点(cut-off)和准确性仍在讨论中. 请阅读:
Reassessment of gamma-glutamyl transpeptidase to platelet ratio (GPR): a large-sample, dynamic study based on liver biopsy in a Chinese population with chronic hepatitis B virus (HBV) infection
重新评估γ-谷氨酰转肽酶与血小板比值（GPR）：一项基于肝活检的大样本动态研究，在中国人群中慢性乙型肝炎病毒（HBV）感染 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890646/
"In conclusion, the accuracy of GPR to diagnose significant fibrosis (F2–4) and extensive fibrosis (F3–4) was comparable to that of APRI, while its accuracy to diagnose cirrhosis (F4) was better. However, its accuracy to diagnose all stages of liver fibrosis was worse compared with FIB-4. In addition, the responsiveness of GPR was greater than that of APRI and FIB-4 during treatment of NAs. Thus, we believe that GPR should be considered as a suitable, simple, non-invasive marker for the diagnosis of liver fibrosis and the dynamic assessment of treatment response in Chinese patients with chronic HBV infection."
"总之，GPR诊断显着纤维化（F2-4）和广泛纤维化（F3-4）的准确性与APRI相当，而诊断肝硬化（F4）的准确性更好。 然而，与FIB-4相比，其诊断肝纤维化各阶段的准确性更差。 此外，GPR治疗期间GPR的反应性高于APRI和FIB-4。 因此，我们认为GPR应该被认为是一种合适的，简单的，非侵入性的肝纤维化诊断标志物和中国慢性HBV感染患者治疗反应的动态评估。"
