AIM To determine the sensitivity and specificity of liver stiffness measurement(LSM) and serum markers(SM) for liver fibrosis evaluation in chronic hepatitis C.METHODS Between 2012 and 2014,81 consecutive hepatitis C ...AIM To determine the sensitivity and specificity of liver stiffness measurement(LSM) and serum markers(SM) for liver fibrosis evaluation in chronic hepatitis C.METHODS Between 2012 and 2014,81 consecutive hepatitis C virus(HCV) patients had METAVIR score from liver biopsy compared with concurrent results from LSM [transient elastography(TE) [FibroS can~/ARFI technology(Virtual Touch~)] and SM [FIB-4/aspartate aminotransferase-toplatelet ratio index(APRI)].The diagnostic performance of these tests was assessed using receiver operating characteristic curves.The optimal cut-off levels of each test were chosen to define fibrosis stages F ≥ 2,F ≥ 3 and F = 4.The Kappa index set the concordance analysis.RESULTS Fifty point six percent were female and the median age was 51 years(30-78).Fifty-six patients(70%) weretreatment-na?ve.The optimal cut-off values for predicting F ≥ 2 stage fibrosis assessed by TE were 6.6 kP a,for acoustic radiation force impulse(ARFI) 1.22 m/s,for APRI 0.75 and for FIB-4 1.47.For F ≥ 3 TE was 8.9 kP a,ARFI was 1.48 m/s,APRI was 0.75,and FIB-4 was 2.For F = 4,TE was 12.2 kP a,ARFI was 1.77 m/s,APRI was 1.46,and FIB-4 was 3.91.The APRI could not distinguish between F2 and F3,P = 0.92.The negative predictive value for F = 4 for TE and ARFI was 100%.Kappa index values for F ≥ 3 METAVIR score for TE,ARFI and FIB-4 were 0.687,0.606 and 0.654,respectively.This demonstrates strong concordance between all three screening methods,and moderate to strong concordance between them and APRI(Kappa index = 0.507).CONCLUSION Given the costs and accessibility of LSM methods,and the similarity with the outcomes of SM,we suggest that FIB-4 as well as TE and ARFI may be useful indicators of the degree of liver fibrosis.This is of particular importance to developing countries.展开更多
AIM: To evaluate the epidemiological, clinical, laboratory and histological variables capable of predicting the progression of hepatic structural disturbances in chronic hepatitis C patients during the time interval b...AIM: To evaluate the epidemiological, clinical, laboratory and histological variables capable of predicting the progression of hepatic structural disturbances in chronic hepatitis C patients during the time interval between two liver biopsies. METHODS: Clinical charts of 112 chronic hepatitis C patients were retrospectively analyzed, whereas liver biopsies were revised. Immunohistochemical detection of interferon receptor was based on the Envision-Peroxidase System. RESULTS: In the multivariate analysis, the variables in the age at first biopsy, ALT levels, presence of lymphoid aggregates and siderosis were the determinants of the best model for predicting the severity of the disease. The direct progression rate of hepatic structural lesions was significantly higher in untreated patients, intermediate in treated non-responders and lower in treated responders to antiviral therapy (non-treated vs responders, 0.22 ± 0.50 vs -0.15 ± 0.46, P = 0.0053). Immuno-expression of interferon receptor is not a relevant factor. CONCLUSION: The best predictors of the progression of fibrosis are age at the first liver biopsy, extent of ALT elevation, inflammation at liver histology and hepatic siderosis. Antiviral treatment is effective in preventing the progression of liver structural lesions in chronic hepatitis C patients.展开更多
文摘AIM To determine the sensitivity and specificity of liver stiffness measurement(LSM) and serum markers(SM) for liver fibrosis evaluation in chronic hepatitis C.METHODS Between 2012 and 2014,81 consecutive hepatitis C virus(HCV) patients had METAVIR score from liver biopsy compared with concurrent results from LSM [transient elastography(TE) [FibroS can~/ARFI technology(Virtual Touch~)] and SM [FIB-4/aspartate aminotransferase-toplatelet ratio index(APRI)].The diagnostic performance of these tests was assessed using receiver operating characteristic curves.The optimal cut-off levels of each test were chosen to define fibrosis stages F ≥ 2,F ≥ 3 and F = 4.The Kappa index set the concordance analysis.RESULTS Fifty point six percent were female and the median age was 51 years(30-78).Fifty-six patients(70%) weretreatment-na?ve.The optimal cut-off values for predicting F ≥ 2 stage fibrosis assessed by TE were 6.6 kP a,for acoustic radiation force impulse(ARFI) 1.22 m/s,for APRI 0.75 and for FIB-4 1.47.For F ≥ 3 TE was 8.9 kP a,ARFI was 1.48 m/s,APRI was 0.75,and FIB-4 was 2.For F = 4,TE was 12.2 kP a,ARFI was 1.77 m/s,APRI was 1.46,and FIB-4 was 3.91.The APRI could not distinguish between F2 and F3,P = 0.92.The negative predictive value for F = 4 for TE and ARFI was 100%.Kappa index values for F ≥ 3 METAVIR score for TE,ARFI and FIB-4 were 0.687,0.606 and 0.654,respectively.This demonstrates strong concordance between all three screening methods,and moderate to strong concordance between them and APRI(Kappa index = 0.507).CONCLUSION Given the costs and accessibility of LSM methods,and the similarity with the outcomes of SM,we suggest that FIB-4 as well as TE and ARFI may be useful indicators of the degree of liver fibrosis.This is of particular importance to developing countries.
基金Supported by Alves de Queiroz Family Fund for Research
文摘AIM: To evaluate the epidemiological, clinical, laboratory and histological variables capable of predicting the progression of hepatic structural disturbances in chronic hepatitis C patients during the time interval between two liver biopsies. METHODS: Clinical charts of 112 chronic hepatitis C patients were retrospectively analyzed, whereas liver biopsies were revised. Immunohistochemical detection of interferon receptor was based on the Envision-Peroxidase System. RESULTS: In the multivariate analysis, the variables in the age at first biopsy, ALT levels, presence of lymphoid aggregates and siderosis were the determinants of the best model for predicting the severity of the disease. The direct progression rate of hepatic structural lesions was significantly higher in untreated patients, intermediate in treated non-responders and lower in treated responders to antiviral therapy (non-treated vs responders, 0.22 ± 0.50 vs -0.15 ± 0.46, P = 0.0053). Immuno-expression of interferon receptor is not a relevant factor. CONCLUSION: The best predictors of the progression of fibrosis are age at the first liver biopsy, extent of ALT elevation, inflammation at liver histology and hepatic siderosis. Antiviral treatment is effective in preventing the progression of liver structural lesions in chronic hepatitis C patients.
