天冬氨酸转氨酶与血小板的比率可以减少中国慢性乙型肝炎

StephenW

Medicine (Baltimore). 2019 Dec;98(49):e18038. doi: 10.1097/MD.0000000000018038.
Aspartate aminotransferase to platelet ratio can reduce the need for transient elastography in Chinese patients with chronic hepatitis B.
Yue W1, Li Y2, Geng J1, Wang P3, Zhang L3,2.
Author information

1
    Department of Infectious Disease, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
2
    Department of VIP Internal Medicine, The First People's Hospital of Yunnan Province.
3
    Faculty of Environmental Science and Engineering, Kunming University of Science and Technology.

Abstract

In the absence of liver biopsy and transient elastography (TE), aspartate aminotransferase to platelet ratio (APRI), fibrosis-4 score (FIB-4), and gammaglutamyl transpeptidase to platelet ratio (GPR) are simple and inexpensive methods for the detection of liver fibrosis.
AIMS:

We compared the performance of APRI, FIB-4, and GPR scores against TE in predicting the presence of liver fibrosis and cirrhosis, determined the optimal cut-off values for fibrosis and cirrhosis prediction, and reviewed the need for further TE assessment in resource-limited areas in China.
METHODS:

TE and basic laboratory tests were performed in 2014 consecutive patients with chronic hepatitis B (CHB), and then compared to APRI, FIB-4, and GPR.
RESULTS:

For the detection of significant fibrosis, the areas under the receiver operating characteristic (AUROC) curves for APRI, FIB-4, and GPR were 0.83, 0.75, and 0.77, respectively. For the detection of cirrhosis, the AUROC curves for APRI, FIB-4, and GPR were 0.90, 0.84, and 0.84, respectively. The cutoff of APRI was 0.35, with 78% sensitivity and 63% negative predictive value (NPV), to exclude significant fibrosis (F ≥ 2). At an APRI of 0.6, results showed a 94% specificity, 100% positive predictive value (PPV) and 7.9 positive likelihood ratio (PLR) in detecting significant fibrosis. Thus, patients with an APRI of <0.35 or >0.6 demonstrated correct prediction of liver fibrosis. These results translated to 1250 out of the 2014 patients avoiding the need for TE with a diagnostic accuracy of >80%.
CONCLUSIONS:

The APRI score accurately assessed fibrosis and reduced the need for TE in almost two-thirds of Chinese patients with CHB.

PMID:
    31804310
DOI:
    10.1097/MD.0000000000018038

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StephenW

医学（巴尔的摩）。 2019年12月; 98（49）：e18038。 doi：10.1097 / MD.0000000000018038。
天冬氨酸转氨酶与血小板的比率可以减少中国慢性乙型肝炎患者进行瞬时弹性成像的需要。
岳W1，李Y2，耿J1，王P3，张L3,2。
作者信息

1个
    云南省第一人民医院传染病科，云南昆明。
2
    云南省第一人民医院VIP内科。
3
    昆明科技大学环境科学与工程学院。

抽象

在没有肝活检和瞬时弹性成像（TE）的情况下，天冬氨酸转氨酶与血小板的比率（APRI），纤维化4评分（FIB-4）和γ-谷氨酰转肽酶与血小板的比率（GPR）是检测肝硬化的简单且廉价的方法肝纤维化。
目的：

我们比较了APRI，FIB-4和GPR得分与TE在预测肝纤维化和肝硬化的存在方面的表现，确定了肝纤维化和肝硬化预测的最佳临界值，并回顾了在资源中进一步评估TE的必要性。中国有限的地区。
方法：

在2014年连续的慢性乙型肝炎（CHB）患者中进行了TE和基础实验室测试，然后与APRI，FIB-4和GPR进行了比较。
结果：

为了检测到明显的纤维化，APRI，FIB-4和GPR的接收器工作特征（AUROC）曲线下的面积分别为0.83、0.75和0.77。为了检测肝硬化，APRI，FIB-4和GPR的AUROC曲线分别为0.90、0.84和0.84。 APRI的临界值为0.35，灵敏度为78％，阴性预测值为63％（NPV），以排除明显的纤维化（F≥2）。在APRI为0.6时，结果显示在检测到明显的纤维化中，特异性为94％，阳性预测值（PPV）为100％，阳性似然比（PLR）为7.9。因此，APRI <0.35或> 0.6的患者证明了肝纤维化的正确预测。这些结果转化为2014名患者中的1250名，从而避免了需要TE且诊断准确率> 80％。
结论：

APRI评分准确评估了纤维化并减少了近三分之二的中国CHB患者的TE需求。

PMID：
    31804310
DOI：
    10.1097 / MD.0000000000018038

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