一种新的非侵入性方案，用于治疗未治疗的慢性乙型肝炎患

StephenW

Clin Transl Gastroenterol. 2019 Apr 25. doi: 10.14309/ctg.0000000000000033. [Epub ahead of print]
A Novel Noninvasive Program for Staging Liver Fibrosis in Untreated Patients With Chronic Hepatitis B.
Chen Y1, Wang Y2, Chen Y3, Yu Z4, Chi X5, Hu KQ6, Li Q7, Tan L8, Xiang D9, Shang Q10, Lei C11, Chen L12, Hu X13, Wang J14, Liu H15, Lu W16, Chi W17, Dong Z1, Wang X3, Li Z4, Xiao H5, Chen D6, Bai W1, Zhang C9, Xiao G11, Qi X12, Chen J13, Zhou L15, Sun H1, Deng M17, Qi X18, Zhang Z1, Qi X19, Yang Y1.
Author information

1
    Center of Therapeutic Research for Liver Cancer, Beijing 302 Hospital, Beijing, China.
2
    Department of Health Statistics, the Fourth Military Medical University, Xi'an, Shanxi Province, China.
3
    Department of Infectious and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
4
    Department of Infectious Disease, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
5
    Traditional Chinese Medicine Hospital of Guangdong Province, Guangdong Province, China.
6
    Division of Gastroenterology and Hepatology, University of California, Irvine, School of Medicine, Orange, California, USA.
7
    Fuzhou Infectious Diseases Hospital, Fuzhou, Fujian Province, China.
8
    Liver Disease Department, Fuyang 2nd People's Hospital, Fuyang, Anhui Province, China.
9
    Department of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China.
10
    Therapeutic Center for Liver Disease, the 88th Hospital of PLA, Taian, Shandong Province, China.
11
    Guangzhou 8th People's Hospital, Guangzhou, Guangdong Province, China.
12
    Department of Hepatic Diseases, Shanghai Public Health Clinical Center, Shanghai, China.
13
    National Integrative Medicine Clinical Base for Infectious Diseases/Department of Infectious Diseases, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
14
    Affiliated Traditional Chinese Medicine Hospital of Luzhou Medical University, Luzhou, Sichuan Province, China.
15
    Traditional Chinese Medicine Hospital of Chongqing, Chongqing, China.
16
    Tianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin, China.
17
    Center for Quantitative Biology, Peking University, Beijing, China.
18
    CHESS, The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
19
    Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning Province, China.

Abstract
OBJECTIVES:

Chronic hepatitis B (CHB) can progress into liver fibrosis and cirrhosis with poor outcomes. Early and accurate diagnosis of liver fibrosis/cirrhosis is important to guide the preventive strategy of their related complications.
METHODS:

A Chinese multicenter cross-sectional study was conducted to develop and validate a novel noninvasive program for staging liver fibrosis in untreated patients with CHB. Liver histology was evaluated independently by 2 pathologists. The alanine aminotransferase ratio, Hepascore, and aspartate aminotransferase to platelet index values were calculated. Liver stiffness measurement (LSM) and diameter of the spleen were measured. Logistic regression with ℓ1 penalty of regression coefficients was used to select the optimal predictors. The diagnostic accuracy for the stage of liver fibrosis was assessed by the area under the receiver operator characteristic curve with 95% confidence interval (CI).
RESULTS:

A total of 1,200 patients with CHB were included, of whom 800 and 400 were in training and validation sets, respectively. LSM, platelets, age, hyaluronic acid, and diameter of the spleen were the top 5 predictors associated with any stage of liver fibrosis and integrated into a novel noninvasive program, named as the Chin-CHB score. The area under the receiver operator characteristic curve of the Chin-CHB score was 0.893 (95% CI: 0.77-0.92) for diagnosing significant fibrosis, 0.897 (95% CI: 0.85-0.95) for advanced fibrosis, and 0.909 (95% CI: 0.87-0.95) for cirrhosis. The diagnostic performance of the Chin-CHB score was similar between training and validation sets. The Chin-CHB score had better diagnostic performance than aspartate aminotransferase to platelet index, alanine aminotransferase ratio, LSM alone, and Hepascore for diagnosing any stage of liver fibrosis.
CONCLUSIONS:

The Chin-CHB score had good diagnostic performance for any stage of liver fibrosis.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PMID:
    31033506
DOI:
    10.14309/ctg.0000000000000033

StephenW

Clin Transl Gastroenterol。 2019年4月25日。土井：10.14309 / ctg.0000000000000033。 [印刷前的电子版]
一种新的非侵入性方案，用于治疗未治疗的慢性乙型肝炎患者的肝纤维化。
Chen Y1，Wang Y2，Chen Y3，Yu Z4，Chi X5，Hu KQ6，Li Q7，Tan L8，Xiang D9，Shang Q10，Lei C11，Chen L12，Hu X13，Wang J14，Liu H15，Lu W16，Chi W17 ，董Z1，王X3，李Z4，肖H5，陈D6，白W1，张C9，肖G11，齐X12，陈J13，周立15，孙H1，邓M17，齐X18，张Z1，齐X19，杨Y1。
作者信息

1
    北京302医院肝癌治疗研究中心，北京
2
    第四军医大学卫生统计学系，山西省西安市。
3
    温州医科大学附属第一医院肝病研究中心传染病与肝病科，浙江省温州市
4
    郑州大学第一附属医院传染病科，河南郑州
五
    广东省中医院，广东省，中国。
6
    美国加利福尼亚州奥兰治市加州大学欧文分校消化内科和肝病学系。
7
    中国福建省福州市福州市传染病医院。
8
    中国安徽省阜阳市富阳市第二人民医院肝病科
9
    第三军医大学西南医院感染科，重庆，中国。
10
    中国人民解放军第88医院肝病治疗中心，山东省泰安市
11
    广州市第八人民医院，广东省广州市。
12
    上海市公共卫生临床中心肝病科，上海
13
    四川省成都市中医药大学附属医院传染病国家中西医结合临床基地/传染病科，中国四川省成都市中医药大学附属医院
14
    泸州医科大学附属中医医院，四川省泸州市
15
    重庆市中医院，重庆，中国。
16
    天津市第二人民医院，天津市肝病研究所，天津
17
    北京大学数量生物学中心，北京，中国。
18
    兰州大学第一医院第五外科，CHESS，兰州，中国。
19
    中国辽宁省沉阳市军区总医院消化内科肝硬化研究组。

抽象
目的：

慢性乙型肝炎（CHB）可进展为肝纤维化和肝硬化，预后不良。早期准确诊断肝纤维化/肝硬化对于指导其相关并发症的预防策略非常重要。
方法：

一项中国多中心横断面研究旨在开发和验证一种新的非侵入性方案，用于在未治疗的CHB患者中进行肝纤维化分期。肝脏组织学由2名病理学家独立评估。计算丙氨酸氨基转移酶比率，Hepascore和天冬氨酸氨基转移酶与血小板指数值。测量肝硬度测量值（LSM）和脾脏直径。使用回归系数的l1罚分的逻辑回归来选择最优预测因子。肝纤维化阶段的诊断准确性通过接受者操作特征曲线下的面积评估，置信区间（CI）为95％。
结果：

共纳入1,200名CHB患者，其中800名和400名分别为训练和验证组。 LSM，血小板，年龄，透明质酸和脾脏直径是与肝纤维化的任何阶段相关的前5个预测因子，并且被整合到新的非侵入性程序中，称为Chin-CHB评分。 Chin-CHB评分的受试者操作特征曲线下面积为0.893（95％CI：0.77-0.92），用于诊断显着纤维化，0.897（95％CI：0.85-0.95）用于晚期纤维化，和0.909（95％CI） ：0.87-0.95）肝硬化。在训练和验证集之间，Chin-CHB评分的诊断性能相似。对于诊断肝纤维化的任何阶段，Chin-CHB评分具有比天冬氨酸氨基转移酶对血小板指数，丙氨酸氨基转移酶比，单独LSM和Hepascore更好的诊断性能。
结论：

Chin-CHB评分对肝纤维化的任何阶段均具有良好的诊断性能。这是根据知识共享署名 - 非商业无衍生物许可证4.0（CCBY-NC-ND）的条款分发的开放获取文章，其中如果被正确引用，则允许下载和共享工作。未经期刊许可，不得以任何方式更改作品或在商业上使用。

结论：
    31033506
DOI：
    10.14309 / ctg.0000000000000033