预测乙肝发炎和纤维化的模型（4月15日于EASL）

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Models to Predict Inflammation and Fibrosis in Patients with Chronic Hepatitis B

The histologic activity index (HAI) has been shown to correlate with antiviral response in patients with chronic hepatitis B (CHB) and fibrosis determines the urgency of treatment.

The aim of this study was to develop models using readily available objective data to predict inflammation and fibrosis in patients with CHB.

Baseline data and liver histology from CHB patients who participated in two trials of adefovir dipivoxil for HBeAg+ (study 437) and HBeAg- (study 438) patients were analyzed. Univariate analyses and logistic regression models were developed to predict inflammation (Knodell necroinflammatory score >8), and fibrosis (Ishak fibrosis score >3).

Results

Inflammation could be predicted using the same model for HBeAg+ and HBeAg- patients consisting of 2 variables, albumin and AST, with an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.74. Models using more variables had marginal improvement in the accuracy of predicting inflammation.

The best model for predicting fibrosis in HBeAg+ patients comprised ALT, age at entry, SAP, PT, AST and bilirubin with an AUROC of 0.77; and, in HBeAg- patients, the best model consisted of platelet, PT, AST/ALT ratio and SAP with an AUROC of 0.83. Work is ongoing to develop a single model with fewer variables for predicting fibrosis in both HBeAg+ and HBeAg- patients.

Conclusion

Models using readily available laboratory and demographic data (complete blood count and serum chemistry) can predict inflammation and fibrosis in patients with CHB and may obviate the need for liver biopsies in some patients.

1University of Michigan, Ann Arbor, MI, USA, 2Armed Forces Institute of Pathology, Washington, D.C., USA, 3Hopital Beaujon, Clichy, France, 4Henry Dunant Hospital, Athens, Greece, 5Gilead Sciences, Inc., Foster City, CA, USA.

04/16/04

Reference
A Lok and others (for the Adefovir Dipivoxil 437 and 438 Study Groups). Models to Predict Inflammation and Fibrosis in Patients with Chronic Hepatitis B. Abstract 436 (poster). 39th EASL. April 14-18, 2004. Berlin, Germany.

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