评估埃及慢性乙型肝炎患者的肝纤维化：一项包括5项无创指

StephenW

Medicine (Baltimore). 2018 Feb;97(6):e9781. doi: 10.1097/MD.0000000000009781.
Assessment of liver fibrosis in Egyptian chronic hepatitis B patients: A comparative study including 5 noninvasive indexes.Tag-Adeen M1, Omar MZ2, Abd-Elsalam FM2, Hasaneen A3, Mohamed MA3, Elfeky HM2, Said EM2, Abdul-Aziz B2, Osman AH4, Ahmed ES5, Osman GS6, Abdul-Samie T7.
Author information
1Department of Internal Medicine, Qena School of Medicine, South Valley University, Qena.2Department of Hepatology, Gastroenterology and Infectious Diseases.3Department of Internal Medicine, Faculty of Medicine, Benha University, Benha.4Department of Hepatology and Gastroenterology, Center of Cardiac and Digestive System Diseases, Sohag.5Department of Clinical Pathology, Faculty of Medicine, Benha University, Benha.6Department of Pathology, Qena School of Medicine, South Valley University, Qena.7Department of Pathology, Faculty of Medicine, Benha University, Benha, Egypt.

AbstractFibrosis assessment in chronic hepatitis B (CHB) is essential for prediction of long-term prognosis and proper treatment decision. This study was conducted to assess predictability of 5 simple noninvasive fibrosis indexes in comparison to liver biopsy in CHB patients.A total of 200 CHB adult Egyptian patients were consecutively included in this study, all were subjected to liver biopsy with staging of fibrosis using METAVIR scoring system. Fibrosis indexes including S-index, red cell distribution width to platelets ratio index (RPR), fibrosis-4 index (Fib-4), AST to platelets ratio index (APRI), and AST/ALT ratio index (AAR) were compared to biopsy result and their predictabilities for the different fibrosis stages were assessed using area under receiver operating characteristic curve (AUROC) analysis.S-index showed the highest AUROCs for predicting fibrosis among the studied indexes. AUROCs of S-index, RPR, Fib-4, APRI, and AAR were: 0.81, 0.67, 0.70, 0.68, and 0.60 for prediction of significant fibrosis (F2-F4), 0.90, 0.66, 0.68, 0.67, and 0.57 for advanced fibrosis (F3-F4), and 0.96, 0.62, 0.61, 0.57, and 0.53 for cirrhosis (F4), respectively. The optimal S-index cutoff for ruling in significant fibrosis was ≥0.3 with 94% specificity, 87% PPV, and 68% accuracy, while that for ruling out significant fibrosis was <0.1 with 96% sensitivity, 91% NPV, and 67% accuracy. Accuracy of S-index was higher for predicting cirrhosis (91%) than that for predicting advanced fibrosis (79%) and significant fibrosis (68%).S-index has the highest predictability for all fibrosis stages among the studied fibrosis indexes in HBeAg-negative CHB patients, with higher accuracy in cirrhosis than in the earlier fibrosis stages.


PMID:29419671DOI:10.1097/MD.0000000000009781

StephenW

3.6 Fibrosis indexes

Fibrosis indexes were calculated as listed below and were then compared to the biopsy result.

    S-index: 1000 × GGT ÷ Platelets × Albumin2.[14]
    RPR: RDWc% ÷ Platelets.[15]
    AST/ALT ratio (AAR): AST ÷ ALT.[16]
    Fib-4: (Age × AST) ÷ (Platelets × √ALT).[17]
    APRI: (AST/ULN ÷ Platelets) × 100, when 40 IU/L was defined as ULN.[18]
https://journals.lww.com/md-jour ... ian_chronic.12.aspx

tacolynn

摘要：慢性乙型肝炎（CHB）中的纤维化评估对于预测长期预后和正确的治疗决定是至关重要的。本研究旨在评估5种简单无创纤维化指标与慢性肝病患者肝活检比较的可预测性。

本研究共纳入200名CHB成年埃及患者，所有患者均使用METAVIR评分系统进行肝活检并进行纤维化分期。

将纤维化指标，包括S指数，红细胞分布宽度与血小板比指数（RPR），纤维化4指数（Fib-4），AST与血小板比指数（APRI）和AST / ALT比值指数（AAR） 采用受试者工作特征曲线下面积（AUROC）分析评估不同纤维化阶段的活检结果及其可预测性.

S-index显示AUROCs预测所研究指标中的纤维化程度最高。

S指数，RPR，Fib-4，APRI和AAR的AUROC分别为：0.81,0.67,0.70,0.68和0.60，用于预测显着纤维化（F2-F4），分别为0.90,0.66,0.68,0.67和0.57 晚期纤维化（F3-F4），肝硬化（F4）分别为0.96,0.62,0.61,0.57和0.53。

治疗显着纤维化的最佳S-指数截断值≥0.3，特异性为94％，PPV为87％，准确性为68％，排除显着纤维化的S指数截断值为<0.1，灵敏度为96％，NPV为91％ 准确性。

S指数对预测肝硬化的准确性（91％）比预测晚期纤维化（79％）和显着纤维化（68％）的准确性更高.S-指数在所研究的纤维化指标中的所有纤维化阶段中对于HBeAg的可预测性最高 CHB患者，肝硬化的准确性高于早期纤维化阶段。

如下所列计算纤维化指数，然后与活检结果进行比较：

S-index: 1000 × GGT ÷ Platelets × Albumin2.

RPR: RDWc% ÷ Platelets.

AST/ALT ratio (AAR): AST ÷ ALT.

Fib-4: (Age × AST) ÷ (Platelets × √ALT).

APRI: (AST/ULN ÷ Platelets) × 100, when 40 IU/L was defined as ULN.

桦子

S-index:1000×谷胺酰转肽酶÷血小板×白蛋白
RPR:红细胞分布宽度÷血小板
AST/ALT ratio (AAR):谷草转氨酶,÷谷丙转氨酶
Fib-4: (年龄 ×谷草转氨酶 ) ÷ (血小板 × 谷丙转氨酶）
APRI: (谷草转氨酶÷参考值上限 ÷ 血小板) × 100,当40单位被定义为参考值上限
√ALT怎么计算？
请问StephenW，上面计算方法是否准确？

StephenW

回复 桦子 的帖子

S-index公式不清楚，应该是:

S-index: (1000×谷胺酰转肽酶)÷(血小板×白蛋白×白蛋白)

√ALT = ALT 平方根 = (ALT)**1/2

桦子

噢，明白了。上面公式好像RPR最重要，它的高低影响到纤维化的程度？
请问HBcrAg是什么？这个指标在血象中有没有体现出来？
谢谢指导！

StephenW

回复 桦子 的帖子

以上研究认为 S-index 最重要. 我个人认为这是有理由的:

白蛋白(Albumin) 小 S-index 更大
血小板(Platelets) 大 S-index 大
S-Index指数越大, 纤维化更严重

S-index  是 上海交通大学医学院附属仁济医院消化内科 2010 发明的.
http://onlinelibrary.wiley.com/d ... 6.2010.06383.x/full

HBcrAg（乙型肝炎核心相关抗原）是一种新的血清生物标志物, 日本发明的. 研究表明它与肝脏中cccDNA的量相关. 因此在指导治疗中(像停药, 或显示不活跃 HBV)非常重要.
检测试剂盒可能不可得到供常用.

桦子

谢谢你的指点。是你博才多学，持之以恒地坚守在翻译中外乙肝资料这个岗位上，为坛友提供学习的平台，
使其重拾战胜乙肝的信心。在新春来临之际，向你致以新春的祝福，祝狗年吉祥、万事如意！

桦子

白蛋白(Albumin) 小 S-index 更大
血小板(Platelets) 大 S-index 大
S-Index指数越大, 纤维化更严重
血小板(Platelets) 大 S-index 大，是不是应该是：血小板(Platelets)小 S-index 大

StephenW

回复 桦子 的帖子

谢谢你, 我写错了.

应该是：血小板(Platelets)小 S-index 大!