非侵袭性纤维化评分的诊断阈值和表现受慢性乙型肝炎患者

StephenW

J Med Virol. 2019 Feb 20. doi: 10.1002/jmv.25435. [Epub ahead of print]
Diagnostic Thresholds and Performance of Non-invasive Fibrosis Scores are Limited by Age in Patients with Chronic Hepatitis B.
Wang W1,2, Zhao X3, Li G4, Wang L1, Chen Y5, Ke M1, Chen G1, Chen T1, Meifang H1, Ning Q1, Zhao X1.
Author information

1
    Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
2
    Department of Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
3
    Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
4
    Department of Heart Function Examination, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
5
    Department of Pathophysiology, Hubei University of Medicine, Shiyan, China.

Abstract
AIM:

We aimed at investigating the effects of age on the predictive performances of non-invasive fibrosis scores for significant fibrosis in patients with chronic hepatitis B (CHB).
METHODS:

A total of 496 CHB patients who underwent liver biopsy were stratified into four age groups: ≤30, 31-40, 41-50 and ≥51 years. Receiver operating characteristic curves were used to evaluate the diagnostic performance of aspartate aminotransferase to platelet ratio index (APRI), fibrosis score-4 (Fib-4) and gamma-glutamyl transpeptidase to platelet ratio (GPR) in different age groups.
RESULTS:

The extent of fibrosis significantly increased with age, and the percentage of significant fibrosis (≥F2) was 21.3%, 29.0%, 38.5% and 46.1%, respectively. All three scores displayed the moderate accuracy to diagnose significant fibrosis in overall patients. However, for patients with age≤30 years, APRI, Fib-4 and GPR performed poorly with the AUROC of 0.567, 0.627 and 0.596, respectively. Furthermore, using the established cut-off values-1.45 for Fib-4, the sensitivity for significant fibrosis increased with age, from 14.8%, 38.1%, 74.5% to 97.87% in above age groups, respectively. To improve the diagnostic accuracy for significant fibrosis, the proposed low and high cut-off points for Fib-4 were 0.41 and 1.15 in ≤30 years, 0.8 and 1.59 in 31-40 years, 1.17 and 1.94 in 41-50 years, 1.76 and 3.10 in ≥51 years, respectively.
CONCLUSIONS:

Age may influence the diagnostic thresholds and performance of APRI, Fib-4 and GPR for significant fibrosis in CHB patients. In particular, these scores performed poorly for identifying significant fibrosis in younger patients (≤30 years). This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

age; aspartate aminotransferase to platelet ratio index; chronic hepatitis B; fibrosis score-4; gamma-glutamyl transpeptidase to platelet ratio; liver fibrosis

PMID:
    30788841
DOI:
    10.1002/jmv.25435

StephenW

J Med Virol。 2019年2月20日。土井：10.1002 / jmv.25435。 [印刷前的电子版]
非侵袭性纤维化评分的诊断阈值和表现受慢性乙型肝炎患者年龄的限制。
Wang W1,2，Zhao X3，Li G4，Wang L1，Chen Y5，Ke M1，Chen G1，Chen T1，Meifang H1，Ning Q1，Zhao X1。
作者信息

1
    华中科技大学同济医学院附属同济医院感染科，武汉
2
    华中科技大学同济医学院附属同济医院临床免疫科，武汉
3
    华中科技大学同济医学院附属同济医院肿瘤科，武汉
4
    华中科技大学同济医学院附属同济医院心功能检查科，武汉
五
    湖北医科大学病理生理学教研室，十堰。

抽象
目标：

我们的目的是研究年龄对慢性乙型肝炎（CHB）患者显着纤维化的非侵袭性纤维化评分的预测性能的影响。
方法：

共有496名接受肝脏活检的CHB患者分为4个年龄组：≤30,31-40,41-50和≥51岁。接受者操作特征曲线用于评估不同年龄组的天冬氨酸氨基转移酶对血小板比率指数（APRI），纤维化评分-4（Fib-4）和γ-谷氨酰转肽酶与血小板比率（GPR）的诊断性能。
结果：

纤维化程度随年龄增长而显着增加，显着纤维化（≥F2）的百分比分别为21.3％，29.0％，38.5％和46.1％。所有三个评分显示中等准确度以诊断整体患者中的显着纤维化。然而，对于年龄≤30岁的患者，APRI，Fib-4和GPR表现不佳，AUROC分别为0.567,0.627和0.596。此外，使用确定的Fib-4临界值-1.45，显着纤维化的敏感性随年龄增长而增加，分别从上述年龄组的14.8％，38.1％，74.5％增加到97.87％。为了提高显着纤维化的诊断准确性，拟议的Fib-4的低和高截止点在≤30年为0.41和1.15,31-40岁为0.8和1.59,11-50岁为1.17和1.94，为1.76和≥5年分别为3.10。
结论：

年龄可能影响APRI，Fib-4和GPR对CHB患者显着纤维化的诊断阈值和表现。特别是，这些评分在识别年轻患者（≤30岁）的显着纤维化方面表现不佳。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

年龄;天冬氨酸氨基转移酶与血小板比值指数;慢性乙型肝炎;纤维化评分-4; γ-谷氨酰转肽酶与血小板比值;肝纤维化

结论：
    30788841
DOI：
    10.1002 / jmv.25435