AASLD2018[2072]优化APRI和FIB-4的使用规则 慢性肝炎患者的肝硬化

StephenW

s 2072
Optimizing the Use of APRI and FIB-4 to Rule
out Cirrhosis in Patients with Chronic Hepatitis
B: Results from the Sonic-B Study
Milan J. Sonneveld1, Willem Pieter Brouwer2, Henry Lik Yuen
Chan3, Teerha Piratvisuth4, Jidong Jia5, Stefan Zeuzem6,
Yun-Fan Liaw7, Bettina E. Hansen8, Hannah S.J. Choi9,
Cynthia Wat10, Qing Xie11, Maria Buti12, Robert J. De Knegt13
and Harry L. A. Janssen8, (1)Erasmus University Medical
Center, (2)Gastroenterology and Hepatology, Erasmus
University Medical Center, (3)Institute of Digestive Disease,
Department of Medicine and Therapeutics, and State Key
Laboratory of Digestive Disease, The Chinese University of
Hong Kong, Hong Kong, (4)Nkc Institute of Gastroenterology
and Hepatology, (5)Liver Research Center, Beijing Friendship
Hospital, Capital Medical University, Beijing Key Laboratory
of Translational Medicine in Liver Cirrhosis, National Clinical
Research Center of Digestive Diseases, Beijing, China;,
(6)Universitätsklinikum Frankfurt, (7)Liver Research Unit,
Chang Gung Memorial Hospital, (8)Toronto Centre for Liver
Disease, University Health Network, (9)University of Toronto,
(10)Roche Products Limited, Roche Products Ltd, (11)
Department of Infectious Diseases, Ruijin Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China,
(12)Hospital Universitari Vall d’Hebron, Barcelona, Spain, (13)
Gastroenterology and Hepatology, Erasmus Medical Centre
Background: Ruling out the presence of cirrhosis is
important for the management of chronic hepatitis B (CHB).
We aimed to study and optimize the performance of 2 noninvasive
indices for ruling out cirrhosis: the AST-platelet ratio
index (APRI) and FIB-4. Methods: We enrolled patients
from 8 global randomized trials that required baseline liver
biopsy and all consecutive biopsied patients from 2 tertiary
referral hospitals in the Netherlands and Canada. We applied
conventional cut-offs to rule in (APRI >2.00; FIB-4 >3.25) or
rule out (APRI <1.00; FIB-4 <1.45) cirrhosis and subsequently
identified and externally validated new cut-offs aiming for a
sensitivity of >90% and a negative predictive value (NPV) of
>95%. Results: We enrolled 3960 patients of whom 1034
were assigned to the validation dataset. In the derivation
dataset (n=2926), 59.8% was Asian and 35.4% Caucasian.
Cirrhosis was detected in 340 (11.6%). Application of
conventional cut-offs for APRI yielded unclassifiable
results in 24.1%, and 45% of patients with cirrhosis were
misclassified as having no cirrhosis. Application of FIB-4
yielded similar results: 23.4% of patients were unclassifiable
and 40.9% of patients with cirrhosis were misclassified as
having no cirrhosis. An APRI <0.45 had an NPV of 95% and
showed 8.5% misclassification in the derivation dataset, but
performance was reduced in the validation set. A FIB-4 score
<0.70 identified ~32% of patients in both the derivation and
validation datasets, with excellent NPVs (>96%) and low
rates of misclassification (5.8% in validation dataset) (table 1).
Conclusion: Conventional cut-offs for APRI and FIB-4 should
not be used to guide management of CHB patients due to
high rates misclassification. A newly identified and externally
validated cut-off for FIB-4 (<0.70) can be used to confidently
exclude cirrhosis.

StephenW

2072
优化APRI和FIB-4的使用规则
慢性肝炎患者的肝硬化
B：Sonic-B研究的结果
Milan J. Sonneveld1，Willem Pieter Brouwer2，Henry Lik Yuen
Chan3，Teerha Piratvisuth4，Jidong Jia5，Stefan Zeuzem6，
Yun-Fan Liaw7，Bettina E. Hansen8，Hannah S.J. Choi9，
Cynthia Wat10，Qing Xie11，Maria Buti12，Robert J. De Knegt13
和Harry L. A. Janssen8，（1）Erasmus University Medical
中心，（2）消化内科和肝脏病学，伊拉斯谟
大学医学中心，（3）消化系疾病研究所，
医学和治疗学系和国家重点
中国人民大学消化系疾病实验室
香港，香港，（4）Nkc消化内科学研究所
和肝脏病学，（5）北京友谊肝脏研究中心
首都医科大学附属医院，北京市重点实验室
转肝医学在肝硬化中的应用，国家临床研究
中国北京消化疾病研究中心;
（6）UniversitätsklinikumFrankfurt，（7）肝脏研究所，
长庚纪念医院，（8）多伦多肝脏中心
疾病，大学健康网，（9）多伦多大学，
（10）罗氏制品有限公司，罗氏制品有限公司，（11）
上海瑞金医院感染科
中国上海交通大学医学院，
（12）西班牙巴塞罗那瓦尔德希伯伦大学医院，（13）
伊拉斯谟医学中心消化内科和肝病学
背景：排除肝硬化的存在是
对慢性乙型肝炎（CHB）的管理很重要。
我们的目的是研究和优化2无创性的表现
排除肝硬化的指标：AST-血小板比率
指数（APRI）和FIB-4。方法：我们招募患者
来自8项需要基线肝脏的全球随机试验
活检和所有连续活检患者来自2名三级医生
荷兰和加拿大的转诊医院。我们申请了
常规截止值（APRI> 2.00; FIB-4> 3.25）或
排除（APRI <1.00; FIB-4 <1.45）肝硬化及其后
确定和外部验证的新的截止目标a
灵敏度> 90％和阴性预测值（NPV）
> 95％。结果：我们招募了3960名患者，其中1034名患者
被分配到验证数据集。在推导中
数据集（n = 2926），59.8％是亚洲人，35.4％是高加索人。
340例（11.6％）检出肝硬化。应用
APRI的常规截止产生了无法分类
结果为24.1％，45％的肝硬化患者为
错误分类为没有肝硬化。 FIB-4的应用
得出了类似的结果：23.4％的患者无法分类
40.9％的肝硬化患者被错误分类为
没有肝硬化。 APRI <0.45的NPV为95％
在派生数据集中显示8.5％的错误分类，但是
验证集中的性能降低了。 FIB-4得分
<0.70确定~32％的患者在推导和
验证数据集，具有优异的NPV（> 96％）和低
错误分类率（验证数据集中为5.8％）（表1）。
结论：APRI和FIB-4的常规截止值应该是
不能用于指导CHB患者的治疗
高利率错误分类。一个新确定的和外部的
FIB-4的验证截止值（<0.70）可以自信地使用
排除肝硬化。

齐欢畅

up