非侵入性纤维化试验的诊断准确性下降与慢性乙型肝炎中丙

StephenW

World J Clin Cases. 2018 Oct 26;6(12):521-530. doi: 10.12998/wjcc.v6.i12.521.
Declining diagnostic accuracy of non-invasive fibrosis tests is associated with elevated alanine aminotransferase in chronic hepatitis B.
Wang L1, Fan YX1, Dou XG2.
Author information

1
    Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China.
2
    Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China. [email protected].

Abstract
AIM:

To explore the effect of alanine aminotransferase (ALT) on the performance of non-invasive fibrosis tests in chronic hepatitis B (CHB) patients.
METHODS:

A total of 599 treatment-naive and biopsy-proven CHB patients were included in the study. The cohort was divided into the following three groups: Normal ALT (ALT ≤ 40), slightly elevated ALT (40 < ALT ≤ 80) and elevated ALT (ALT > 80). The diagnostic performance of five common non-invasive fibrosis tests for liver fibrosis (stages S2-4), including the aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI), fibrosis index based on 4 factors (FIB-4), King's score, Forns index and gamma-glutamyl transpeptidase (GGT)-to-PLT ratio (GPR), were evaluated for each group.
RESULTS:

Higher ALT levels were associated with higher non-invasive fibrosis test scores. Patients with the same fibrosis stage but higher ALT levels showed higher non-invasive test scores. The areas under the receiver operating characteristics curves (AUROCs) of the non-invasive tests for prediction of ≥ S2 were higher for patients with ALT ≤ 40 U/L (range 0.705-0.755) and 40 < ALT ≤ 80 U/L (range 0.726-0.79) than for patients with ALT > 80 U/L (range 0.604-0.701). The AUROCs for predicting ≥ S3 and S4 were higher in patients with ALT ≤ 40 U/L (range 0.736-0.814 for ≥ S3, 0.79-0.833 for S4) than in patients with 40 < ALT ≤ 80 U/L (range 0.732-0.754 for ≥ S3, range 0.626-0.723 for S4) and ALT > 80 U/L (range 0.7-0.784 for ≥ S3, range 0.662-0.719 for S4). The diagnostic accuracy of the non-invasive tests decreased in a stepwise manner with the increase in ALT.
CONCLUSION:

ALT has a significant effect on the diagnostic performance of non-invasive fibrosis tests. The ALT level should be considered before performing these non-invasive tests.
KEYWORDS:

Alanine aminotransferase; Chronic hepatitis B; Inflammation; Liver fibrosis; Non-invasive tests

PMID:
    30397608
PMCID:
    PMC6212603
DOI:
    10.12998/wjcc.v6.i12.521

StephenW

世界J Clin案件。 2018年10月26日; 6（12）：521-530。 doi：10.12998 / wjcc.v6.i12.521。
非侵入性纤维化试验的诊断准确性下降与慢性乙型肝炎中丙氨酸氨基转移酶升高有关。
王一，范YX1，窦XG2。
作者信息

1
    中国医科大学附属盛京医院感染科，辽宁省沉阳市110022
2
    中国医科大学附属盛京医院感染科，辽宁省沉阳市110022 [email protected]。

抽象
目标：

探讨丙氨酸氨基转移酶（ALT）对慢性乙型肝炎（CHB）患者非侵袭性纤维化试验的影响。
方法：

本研究共纳入599例未经治疗和活检证实的CHB患者。该队列分为以下三组：正常ALT（ALT≤40），轻度升高的ALT（40 <ALT≤80）和升高的ALT（ALT> 80）。五种常见的非侵入性纤维化试验对肝纤维化（S2-4期）的诊断性能，包括天冬氨酸氨基转移酶（AST） - 血小板（PLT）比值指数（APRI），基于4种因素的纤维化指数（FIB- 4），评估每组的King's评分，Forns指数和γ-谷氨酰转肽酶（GGT）-to-PLT比（GPR）。
结果：

较高的ALT水平与较高的非侵入性纤维化测试分数相关。具有相同纤维化阶段但ALT水平较高的患者显示出更高的非侵入性测试分数。对于ALT≤40U / L（范围0.705-0.755）和40 <ALT≤80U / L（范围）的患者，预测≥S2的非侵入性试验的受试者操作特征曲线（AUROCs）下的面积更高0.726-0.79）比ALT> 80 U / L（范围0.604-0.701）的患者。 ALT≤40U / L（≥3S范围为0.736-0.814，S4为0.79-0.833）患者的预测≥S3和S4的AUROCs高于40 <ALT≤80U/ L（范围0.732-）的患者对于≥S3，为0.754，对于S4，范围为0.626-0.723，并且ALT> 80U / L（对于≥S3，范围为0.7-0.784，对于S4，范围为0.662-0.719）。随着ALT的增加，非侵入性测试的诊断准确性逐步降低。
结论：

ALT对非侵入性纤维化试验的诊断性能有显着影响。在进行这些非侵入性测试之前，应考虑ALT水平。
关键词：

丙氨酸氨基转移酶;慢性乙型肝炎;炎;肝纤维化;非侵入性测试

结论：
    30397608
PMCID：
    PMC6212603
DOI：
    10.12998 / wjcc.v6.i12.521

StephenW

https://www.wjgnet.com/2307-8960/full/v6/i12/521.htm