伽玛谷氨酰转移到血小板比率预测肝纤维化和肝硬化HBeAg阳性

StephenW

J Viral Hepat. 2016 Jul 4. doi: 10.1111/jvh.12563. [Epub ahead of print]
The gamma-glutamyl transpeptidase-to-platelet ratio predicts liver fibrosis and cirrhosis in HBeAg-positive chronic HBV infection patients with high HBV DNA and normal or mildly elevated alanine transaminase levels in China.Li Q1, Li W1, Huang Y1, Chen L1.
Author information

• 1Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  

AbstractThe gamma-glutamyl transpeptidase-to-platelet ratio (GPR) is a new serum diagnostic model, which is reported to be more accurate than aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for the diagnosis of significant fibrosis and cirrhosis in chronic HBV infection (CHBVI) patients in West Africa. To evaluate the performance of the GPR model for the diagnosis of liver fibrosis and cirrhosis in HBeAg-positive CHBVI patients with high HBV DNA (≥5 log10 copies/mL) and normal or mildly elevated alanine transaminase (ALT) (≤2 times upper limit of normal (ULN)) in China. A total of 1521 consecutive CHBVI patients who underwent liver biopsies and routine laboratory tests were retrospectively screened. Of these patients, 401 treatment naïve HBeAg-positive patients with HBV DNA≥5 log10 copies/mL and ALT≤2 ULN were included. The METAVIR scoring system was adopted as the pathological diagnosis standard of liver fibrosis. Using liver histology as a gold standard, the performances of GPR, APRI, and Fib-4 for the diagnosis of liver fibrosis and cirrhosis were evaluated and compared by receiver operating characteristic (ROC) curves and the area under the ROC curves (AUROCs). Of 401 patients, 121 (30.2%), 49 (12.2%) and 17 (4.2%) were classified as having significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4), respectively. After estimating the AUROC to predict significant fibrosis, the performance of GPR (AUROC=0.66, 95% CI 0.60-0.72) was higher than APRI (AUROC=0.58, 95% CI 0.52-0.64, P=.002) and Fib-4 scores (AUROC=0.54, 95% CI 0.47-0.60, P<.001). After estimating the AUROC to predict severe fibrosis, the performance of GPR (AUROC=0.71, 95% CI 0.63-0.80) was also higher than APRI (AUROC=0.65, 95% CI 0.56-0.73, P=.003) and Fib-4 scores (AUROC=0.67, 95% CI 0.58-0.75, P=.001). After estimating the AUROC to predict cirrhosis, the performance of GPR (AUROC=0.73, 95% CI 0.56-0.88) was higher than APRI (AUROC=0.69, 95% CI 0.54-0.83, P=.041) and Fib-4 scores (AUROC=0.69, 95% CI 0.55-0.82, P=.012) too. The GPR is a new serum model for the diagnosis of liver fibrosis and cirrhosis and shows obvious advantages in Chinese HBeAg-positive patients with HBV DNA≥5 log10 copies/mL and ALT≤2 ULN compared with APRI and Fib-4, thus warranting its widespread use for this specific population.
© 2016 John Wiley & Sons Ltd.


KEYWORDS: aspartate transaminase-to-platelet ratio index; chronic hepatitis B; cirrhosis; fibrosis; gamma-glutamyl transpeptidase-to-platelet ratio

PMID:27375134DOI:10.1111/jvh.12563

StephenW

Ĵ病毒Hepat。 2016年4月DOI：10.1111 / jvh.12563。 [打印EPUB提前]
伽玛谷氨酰转移到血小板比率预测肝纤维化和肝硬化HBeAg阳性慢性HBV感染患者的高HBV DNA和在中国正常或轻度升高丙氨酸转氨酶水平。
李Q1，李W1，黄Y1，陈L1。
作者信息

    1Shanghai公共卫生临床中心，复旦大学，上海，中国。

抽象

伽马谷氨酰转到血小板比率（GPR）是一种新的血清诊断模型，这是据报道，比基于四个因素天冬氨酸转氨酶对血小板比率指数（APRI）和纤维化指数更准确的（Fib- 4）对慢性HBV感染（CHBVI）的患者在西非显著纤维化和肝硬化的诊断。要为肝纤维化和肝硬化的HBeAg阳性CHBVI患者的诊断具有较高的HBV DNA（≥5log10拷贝/ mL）和正常或轻度升高丙氨酸转氨酶（ALT）评估GPR模型的性能（≤2次上限标准上限（ULN）的）在中国。共有1521谁接受肝活检和常规化验连续CHBVI患者进行回顾性审查。在这些患者中，401初次接受治疗HBeAg阳性患者的HBVDNA≥5log10拷贝/ mL和ALT≤2ULN都包括在内。该METAVIR评分系统被采纳为肝纤维化的病理诊断标准。使用肝组织学作为金标准，探地雷达，APRI和FIB-4的肝纤维化和肝硬化的诊断性能进行评估，并通过接收器中的ROC曲线（AUROCs）下工作特征（ROC）曲线和区域进行比较。 401例，121（30.2％），49（12.2％）和17（4.2％）被列为分别具有显著纤维化（≥F2），严重纤维化（≥F3），肝硬化（= F4）。估计AUROC预测显著纤维化后，GPR（AUROC = 0.66，95％CI 0.60-0.72）的性能比APRI（AUROC = 0.58，95％CI 0.52-0.64，P = 0.002）和FIB-4较高评分（AUROC = 0.54，95％CI 0.47-0.60，P <0.001）。估计AUROC预测严重纤维化后，GPR（AUROC = 0.71，95％CI 0.63-0.80）的性能比APRI（AUROC = 0.65，95％CI 0.56-0.73，P = 0.003）和Fib-也较高分数（AUROC = 0.67，95％CI 0.58-0.75，P = 0.001）。估计AUROC预测肝硬化后，GPR（AUROC = 0.73，95％CI 0.56-0.88）的性能比APRI（AUROC = 0.69，95％CI 0.54-0.83，P = 0.041）和FIB-4高比分（AUROC = 0.69，95％CI 0.55-0.82，P = 0.012）了。探地雷达是肝纤维化和肝硬化的诊断提供了新的血清模式，显示了中国HBeAg阳性患者的HBVDNA≥5log10拷贝/ mL和ALT≤2ULN与APRI和FIB-4，从而保证效相比优势明显的广泛使用此特定的人口。

2016年©约翰·威利父子有限公司
关键词：

天冬氨酸转氨酶到血小板比率指标;慢性乙型肝炎;肝硬化;纤维化;伽玛谷氨酰转到血小板比率

结论：
    27375134
DOI：
    10.1111 / jvh.12563