非侵入性的评分系统纤维化慢性肝炎：基于生化，肝纤维和

StephenW

Non-invasive score system for fibrosis in chronic hepatitis: proposal for a model based on biochemical, FibroScan and ultrasound data

    Silvia Gaia1,*, Daniela Campion1, Andrea Evangelista2, Maurizio Spandre1, Loretta Cosso1, Franco Brunello1, Giovannino Ciccone2, Elisabetta Bugianesi1 andMario Rizzetto1

Article first published online: 21 JAN 2015

DOI: 10.1111/liv.12761

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Issue

Liver International

Volume 35, Issue 8, pages 2027–2035, August 2015


    1    Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
    2    Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy

* Correspondence
Silvia Gaia, MD, Department of Gastroenterology, Città della Salute e della Scienza – University Hospital of Turin, c.so Bramante 88, 10100 Turin, Italy
Tel: +390116336485
Fax: +390116336752
e-mail: [email protected]

    Handling Editor: Helena Cortez-Pinto

Publication History

    Issue published online: 29 JUL 2015
    Article first published online: 21 JAN 2015
    Accepted manuscript online: 14 DEC 2014 11:29PM EST
    Manuscript Accepted: 2 DEC 2014
    Manuscript Received: 24 JUL 2014


Keywords:

    chronic viral hepatitis;FibroScan;liver biopsy; NAFLD ;non-invasive fibrosis;ultrasound scan

Abstract
Background & Aims

We elaborate a non-invasive score system for liver fibrosis (NISF), exploring its diagnostic performance and comparing its accuracy to FibroScan in patients with chronic viral hepatitis (CH) and non-alcoholic fatty liver disease (NAFLD).
Methods

Clinical, biochemical, elastographic and ultrasound parameters derived from patients with CH (n = 83) or NAFLD (n = 58), undergoing liver biopsy for fibrosis assessment, were prospectively collected as potential predictors of fibrosis. Each parameter was evaluated for its correlation with the liver biopsy (Gold Standard). Candidate predictors with good interobserver agreement and correlation with histological stages were combined into two algorithms (NISF) to predict fibrosis in chronic viral hepatitis and NAFLD.
Results

The CH-NISF included six parameters: bluntness of liver edges, irregularity of left lobe surface, diameter of segment 4, liver stiffness measurement, platelet count and ALT values. The ability of the model to discriminate F3–F4 vs F0–F1 stages and F2 vs F0-F1 was high (AUROC of 0.95 and 0.83 respectively) and better than FibroScan alone, especially in intermediate stages (F2 vs F0-F1), AUROC 0.83 vs 0.57 (P = 0.003). The resulting algorithm is available as mathematical formula, nomogram or free online link. [http://health.mafservizi.it/NISF_Calculator/liver.htm]

The NAFLD-NISF included liver stiffness, platelet count and AST levels, had good ability to discriminate F0–F1 vs F2–F3–F4 stages (AUROC 0.86), however, not significantly higher than FibroScan.
Conclusions

CH-NISF can be proposed as preliminary and easily available staging tool, superior to FibroScan alone in predicting histological fibrosis, especially in intermediate stages. Further validations are needed to improve NISF accuracy in NAFLD.

StephenW

非侵入性的评分系统纤维化慢性肝炎：基于生化，肝纤维和超声数据建议模型

    西尔维娅Gaia1，*，丹妮拉Campion1，安德烈Evangelista2，莫里吉奥Spandre1，洛雷塔Cosso1，佛朗哥Brunello1，Giovannino Ciccone2，伊丽莎白Bugianesi1 andMario Rizzetto1

文章首次在线发表：2015年1月21日

DOI：10.1111 / liv.12761

2014年©约翰·威利父子A / S。由John Wiley＆Sons出版有限公司

问题

肝国际

第35卷，第8期，页2027-2035，2015年8月


    大学医院，都灵，意大利 - 消化内科，的Cittàdella Salute的Ë德拉Scienza的1系
    大学医院，都灵，意大利 - 流行病学的Cittàdella Salute的Ë德拉Scienza的2部

*通讯
西尔维娅盖亚医师，消化内科，的Cittàdella Salute的Ë德拉Scienza系 - 都灵大学医院，c.so布拉曼特88，10100都灵，意大利
联系电话：390116336485
传真：390116336752
电子邮件：[email protected]

    处理编辑：海伦娜科特斯 - 平托

出版物历史

    问题在网上公布：2015年7月29日
    文章首次在线发表：2015年1月21日
    接受稿件在线：2014年12月14日下午11:29 EST
    稿件接受：2014年12月2日
    收稿：2014年7月24日


关键词：

    慢性病毒性肝炎，肝纤维;肝活检; NAFLD;非侵入性纤维化;超声波扫描

抽象
背景与目的

我们阐述肝纤维化的非侵入性的得分系统（NISF），探索其诊断性能和其精度在慢性病毒性肝炎（CH）和非酒精性脂肪肝病（NAFLD）比较肝纤维。
方法

来自患者的CH（N = 83）或NAFLD（N = 58）的临床，生化，弹性成像和超声参数，接受肝活检纤维化评估，前瞻性收集纤维化的潜在危险因素。每个参数与肝活检（金标准）的相关性进行了评估。候选预测具有很好的观察者间的一致性和相关性与组织阶段合并为两种算法（NISF）预测纤维化慢性病毒性肝炎和脂肪肝。
结果

这架CH-NISF包括六个参数：肝脏边缘，左叶表面的不规则，段4的直径，肝脏硬度测量，血小板计数和ALT值钝化。该模型的区分F3-F4 VS F0-F1阶段和F2 VS F0-F1的能力是高（分别为0.95和0.83 AUROC），比单纯肝纤维更好，尤其是在中间阶段（F2 VS F0-F1），AUROC 0.83 0.57 VS（P = 0.003）。由此产生的算法是作为数学公式，列线图或免费在线链接。 [http://health.mafservizi.it/NISF_Calculator/liver.htm]

该NAFLD-NISF包括肝脏硬度，血小板计数和AST水平，必须区分F0-F1 F2 VS-F3-F4级（AUROC 0.86）能力强，但是，不显著高于肝纤维高。
结论

CH-NISF可以被提议为初步的和容易获得分期工具，效果优于单用Fibroscan的预测组织纤维化，尤其是在中间阶段。还需要进一步的验证，以提高NISF准确性NAFLD。