丙氨酸氨基转移酶影响常规性能的检测乙型肝炎相关性肝硬

StephenW

J Viral Hepat. 2020 Mar 18. doi: 10.1111/jvh.13293. [Epub ahead of print]
Alanine Aminotransferase Influencing Performances of Routine Available Tests Detecting Hepatitis B Related Cirrhosis.
Chen YP1,2,3, Huang LW4, Lin XY1, Hu XM2, Liang XE1, Rong-Long J1,2.
Author information

1
    Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
2
    Hepatology Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, 518110, China.
3
    Department of Internal Medicine, Nanfang Hospital Taihe Branch, Guangzhou, 510540, China.
4
    Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, 528308, China.

Abstract

The performances of routine tests such as FIB-4 and APRI in detecting cirrhosis and significant fibrosis in chronic hepatitis B (CHB) have been shown to be discrepant between studies. Novel tests such as cell distribution width-platelet ratio (RPR), γ-glutamyl transpeptidase to platelet ratio (GPR) and easy liver fibrosis test (eLIFT) have also been introduced recently. To evaluate the aminotransferase influence on the performance of these routine tests, a total of 1005 CHB patients who underwent liver biopsies and routine tests were retrospectively analyzed. The diagnostic cutoffs referring to likelihood ratio were determined for excluding or including cirrhosis diagnosis, and also for ruling in significant fibrosis diagnosis. The performances ofRPR, FIB-4, eLIFT and APRI in detecting cirrhosis seemed improved at higher ALTlevels, whilst PR was conversely impaired. The likelihood ratios of APRI 2 in diagnosing cirrhosisatALT< 2 upper limit of normal (ULN), APRI 1.5 in determining significant fibrosisatALT ≤5ULN and-4 3.2 in diagnosing ≥Metavir F3 in the total cohort was∝, 14.6 and 20.6, respectively. The optimal cutoffs for cirrhosis diagnosis were increased with higher ALTs by tests which included aminotransferase level, but not for RPR. The proportions of patients classified as having cirrhosis or no cirrhosis stratified by ALT level cutoffs were superior. Stepwise applying RPR, GPR and eLIFT would determine 60% of patients as having cirrhosis or no cirrhosis with an accuracy of 93.0%. In conclusion, the performance of aminotransferase comprising tests in detecting cirrhosis in CHB were influenced by ALT levels. Thus ALT stratified cutoffs may be a preferred alternative. In resource-limited settings, stepwise applying routine tests could be recommended as a preferred measurement for cirrhosis detection.

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KEYWORDS:

Aminotransferase; Chronic hepatitis B; Cirrhosis; Routine test; Significant fibrosis; Stepwise application

PMID:
    32187804
DOI:
    10.1111/jvh.13293

StephenW

J病毒性肝炎。 2020年3月18日。doi：10.1111 / jvh.13293。 [Epub提前发行]
丙氨酸氨基转移酶影响常规性能的检测乙型肝炎相关性肝硬化的表现。
Chen YP1,2,3，Huang LW4，Lin XY1，Hu XM2，Liang XE1，Rong-Long J1,2。
作者信息

1个
    南方医科大学附属南方医院感染科，广东广州510515
2
    南方医科大学深圳医院肝病科，深圳518110
3
    南方医院太和分院内科，广东广州510540
4
    南方医科大学附属顺德医院感染科，广东顺德528308。

抽象

研究表明，FIB-4和APRI等常规测试在检测慢性乙型肝炎（CHB）的肝硬化和严重纤维化中的表现存在差异。最近还引入了诸如细胞分布宽度-血小板比（RPR），γ-谷氨酰转肽酶与血小板比（GPR）和易肝纤维化测试（eLIFT）等新方法。为了评估转氨酶对这些常规检查性能的影响，回顾性分析了总共1005例接受肝活检和常规检查的CHB患者。确定排除似然比的诊断临界值，以排除或包括肝硬化诊断，也用于重大纤维化诊断的裁定。在较高的ALT水平下，RPR，FIB-4，eLIFT和APRI检测肝硬化的性能似乎有所改善，而PR则相反。 ALT <2正常上限（ULN）时，APRI 2诊断肝硬化的可能性比率； ALT≤5ULN时确定严重纤维化的APRI 1.5；≥MetavirF3的总队列诊断中-4的可能性比率分别为∝，14.6和20.6。通过更高的ALT（包括氨基转移酶水平）而不是RPR可以提高肝硬化诊断的最佳临界值。根据ALT水平临界值分级为肝硬化或无肝硬化的患者比例较高。逐步应用RPR，GPR和eLIFT将确定60％的患者患有肝硬化或无肝硬化，其准确率为93.0％。总之，包括ALT在内的氨基转移酶测试在检测CHB肝硬化中的作用受到影响。因此，ALT分层临界值可能是首选方案。在资源有限的环境中，建议逐步应用常规测试作为肝硬化检测的首选方法。

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关键字：

氨基转移酶慢性乙型肝炎；肝硬化；例行测试；明显的纤维化；逐步申请

PMID：
    32187804
DOI：
    10.1111 / jvh.13293