AASLD2020[1544]非侵入性方法的实时预测值 声辐射力脉冲（ARFI）

StephenW

1544
PREDICTIVE VALUE OF NON-INVASIVE METHODS LIVERFAST,
ACOUSTIC RADIATION FORCE IMPULSE (ARFI), FIB-4 AND
APRI TO IDENTIFY THE NATURAL PHASES OF CHRONIC
HEPATITIS B (CHB) INFECTION FROM THE NATIONAL
UNIVERSITY HOSPITAL (NUH) CHB STUDY COHORT OF
SINGAPORE
Seng Gee Lim1, Amy Tay1, Htet Htet Toe Wai Khine1, Janine
Marcos Dangbis1, Teresa Gonzalo2 and Ronald Quiambao2,
(1)Division of Gastroenterology and Hepatology, National
University Health System, Singapore, (2)Medical Affairs,
Fibronostics
Background: In order to determine the outcomes and
progression to significant liver fibrosis (SLF) as per ARFI,
we set up a prospective NUH HBV cohort with chronic HBV
infection (Ch.Inf) expected to have no/minimal liver disease
vs moderate/severe in chronic hepatitis (Ch.Hep) patients
(pts) (JHepatol2017) LIVERFAStTM (LF, Fibronostics, US),
is a patented technology to assess liver fibrosis(LF-F) and
activity(LF-A) Aim To estimate the negative predictive
value (NPV) and the discriminating value between Ch.Inf
and Ch.Hep with non-invasive tests LF-F, LF-A, ARFI, FIB-4
and APRI, in CHB pts from the NUH Singapore HBV cohort
Methods: Prospective naïve CHB pts aged >21yrs, with
ARFI<1.54m/s, were included. HBV phases were defined
on HBeAg presence, HBVDNA(VL, IU/mL) and ALT(IU/L):
Ch.Inf.HBe+[VL>107,ALT<40]; Ch.Hep.HBe+[VL104–
107,ALT>40]; Ch.Inf.HBe-[VL<2,000,ALT<40]; Ch.Hep.
HBe-[VL>2,000,ALT>40]; indeterminate (not all criteria)
and resolved HBV [HBsAg(-), VL<10,ALT<40,anti-HBc+]
Results: 724pts were included, [26 excluded (6 missing
data; 7 ARFI>1.54m/s; 13 LF not applicable)] with the main
characteristics [mean(se)] age 50(0 4)yrs, 51 7%males, 89 9%
HBeAg-, ALT 31(1)IU/l, VL 2,4x107(4643) IU/ml, qHBsAg
5428(758), ARFI 1.06(0,01). Prevalence of CHB profiles were:
60(8 3%) Ch.Hep.HBe-; 195(26 9%) Ch.Inf.HBe-; 33(4 6%)
Ch.Hep.HBe+; 24(3 3%) Ch.Inf.HBe+; 32(4 4%) HBsAg
nonReact and 380(52 5%) indeterminate (50 3%HBe-)
Spearman correlations of LF-Fib/LF-Act with ARFI, FIB-4 and
APRI were 0 18/0 21, 0 47/0 11 and 0 23/0 69, respectively (all
p<0 01) In HBeAg(-)pts, Ch.InfHBe- phase was discriminated
from Ch.HepHBe- as per liver disease estimators LF-Fib
(0 23vs0 28,p<0 05), LF-Act (0 07vs0 23,p<0 001) and APRI
(0 28vs0 44,p<0 001), respectively In HBeAg(+) pts, Ch.Inf
HBe+ phase was discriminated from Ch.HepHBe+ as per
LF-Fib (0 10vs0 19,p<0 001), LF-Act (0 09vs0 31,p<0 001),
and APRI (0 32vs0 46,p<0 001) ARFI and FIB-4 did not
discriminate Ch.Inf from Ch.Hep in both HBeAg+/-(p=NS)
NPV for LF-Fib/LF-Act/APRI were for HBe(-) 77%/82%/27%
and HBe(+) 89%/62%/12%, respectively Resolved HBV
had significantly lower activity than Ch.HepHBe- as per LFAct
(0 11vs 0 23, p<0 001) Among 6 pts (0 8%) that scored
F4 stage as per LF-Fib and F0 as per ARFI, 3 had false
positive LF-Fib Conclusion: LF-fib and LF-Act are reliable
tools for screening HBV infected patients and for detecting
phase-related liver disease, with better NPV than APRI or
FIB-4 Management of HBV pts could be improved by LF
tests.

StephenW

1544
非侵入性方法的实时预测值
声辐射力脉冲（ARFI），FIB-4和
识别慢性的自然相
来自国家的乙型肝炎（CHB）感染
的大学医院（NUH）CHB研究队列
新加坡
Seng Gee Lim1，Amy Tay1，Htet Htet Toe Wai Khine1，Janine
Marcos Dangbis1，Teresa Gonzalo2和Ronald Quiambao2，
（1）全国消化内科
新加坡大学医疗系统，（2）医疗事务，
纤维动力学
背景：为了确定结果和
根据ARFI进展为严重肝纤维化（SLF），
我们建立了一个预期的NUH HBV人群与慢性HBV
预计没有/最小的肝病感染（Ch.Inf）
与慢性肝炎（Ch.Hep）患者的中度/重度
（pts）（JHepatol2017）LIVERFAStTM（LF，Fibronostics，US），
是一项评估肝纤维化（LF-F）和
活动（LF-A）目的估计负面预测
值（NPV）和Ch.Inf之间的区分值
和Ch.Hep进行无创测试LF-F，LF-A，ARFI，FIB-4
和APRI，来自NUH新加坡HBV队列的CHB积分
方法：年龄≥21岁的前瞻性初次CHB患者，
包括ARFI <1.54m / s。定义了HBV阶段
检测HBeAg，HBVDNA（VL，IU / mL）和ALT（IU / L）：
Ch.Inf.HBe + [VL> 107，ALT <40]; Ch.Hep.HBe + [VL104–
107，ALT> 40]; Ch.Inf.HBe- [VL <2,000，ALT <40];希普
HBe- [VL> 2,000，ALT> 40]；不确定（并非所有条件）
和已解析的HBV [HBsAg（-），VL <10，ALT <40，抗HBc +]
结果：包括724分，[26排除在外（6失踪
数据; 7 ARFI> 1.54m / s； 13 LF不适用）]
特征[平均（se）]年龄50（0 4）岁，男51 7％，男89 9％
HBeAg-，ALT 31（1）IU / l，VL 2,4x107（4643）IU / ml，qHBsAg
5428（758），ARFI 1.06（0,01）。 CHB配置文件的患病率是：
60（8 3％）Chep.HBe-; 195（26 9％）Chf.Inf.HBe-; 33（4 6％）
Ch.Hep.HBe +; 24（3 3％）Chf.HBe +; 32（4 4％）乙肝表面抗原
不反应和380（52 5％）不确定（50 3％HBe-）
LF-Fib / LF-Act与ARFI，FIB-4和
APRI分别为0 18/0 21、0 47/0 11和0 23/0 69（全部
p <0 01）在HBeAg（-）pts中，Ch.InfHBe-相被区分
来自Ch.HepHBe-根据肝脏疾病估计量LF-Fib
（0 23vs0 28，p <0 05），LF-Act（0 07vs0 23，p <0 001）和APRI
（0 28vs0 44，p <0 001）分别在HBeAg（+）pts中，Ch.Inf
按照以下方法将HBe +相与Ch.HepHBe +相区别
LF-Fib（0 10vs0 19，p <0 001），LF-Act（0 09vs0 31，p <0 001），
和APRI（0 32vs0 46，p <0 001）ARFI和FIB-4没有
在两种HBeAg +/-（p = NS）中将Ch.Inf与Ch.Hep区分开
LF-Fib / LF-Act / APRI的NPV为HBe（-）77％/ 82％/ 27％
和HBe（+）分别为89％/ 62％/ 12％
根据LFAct，其活性明显低于Ch.HepHBe-
（0 11vs 0 23，p <0 001）在6分（0 8％）中
根据LF-Fib进行的F4阶段和根据ARFI进行的F0，其中3个为假
LF-Fib阳性结论：LF-fib和LF-Act是可靠的
乙肝病毒感染患者筛查和检测工具
阶段性肝病，NPV优于APRI或
LF可以改善FIB-4对HBV患者的管理
测试。