AIM:To assess the usefulness of FibroTest to forecast scores by constructing decision trees in patients with chronic hepatitis C.METHODS:We used the C4.5 classification algorithm to construct decision trees with data ...AIM:To assess the usefulness of FibroTest to forecast scores by constructing decision trees in patients with chronic hepatitis C.METHODS:We used the C4.5 classification algorithm to construct decision trees with data from 261 patients with chronic hepatitis C without a liver biopsy.The FibroTest attributes of age,gender,bilirubin,apolipoprotein,haptoglobin,α2 macroglobulin,and γ-glutamyl transpeptidase were used as predictors,and the FibroTest score as the target.For testing,a 10-fold cross validation was used.RESULTS:The overall classification error was 14.9%(accuracy 85.1%).FibroTest's cases with true scores of F0 and F4 were classified with very high accuracy(18/20 for F0,9/9 for F0-1 and 92/96 for F4) and the largest confusion centered on F3.The algorithm produced a set of compound rules out of the ten classification trees and was used to classify the 261 patients.The rules for the classification of patients in F0 and F4 were effective in more than 75% of the cases in which they were tested.CONCLUSION:The recognition of clinical subgroups should help to enhance our ability to assess differences in fibrosis scores in clinical studies and improve our understanding of fibrosis progression.展开更多
AIM: To investigate the liver stiffness measurement (LSM) applicability and variability with reference to three probe positions according to the region of liver biopsy. METHODS: The applicability for LSM was defined a...AIM: To investigate the liver stiffness measurement (LSM) applicability and variability with reference to three probe positions according to the region of liver biopsy. METHODS: The applicability for LSM was defined as at least 10 valid measurements with a success rate greater than 60% and an interquartile range/median LSM < 30%. The LSM variability compared the inter-position concordance and the concordance with FibroTest. RESULTS: Four hundred and forty two consecutive patients were included. The applicability of the anterior position (81%) was significantly higher than that of the reference (69%) and lower positions (68%), (both P = 0.0001). There was a signif icant difference (0.5 kPa, 95% CI 0.13-0.89; P < 0.0001) between mean LSM estimated at the reference position (9.3 kPa) vs the anterior position (8.8 kPa). Discordance between positions was associated with thoracic fold (P = 0.008). The discordance rate between the reference position result and FibroTest was higher when the 7.1 kPa cutoff was used to define advanced fibrosis instead of 8.8 kPa (33.6% vs 23.5%, P = 0.03).CONCLUSION: The anterior position of the probe should be the fi rst choice for LSM using Fibroscan, as it has a higher applicability without higher variability compared to the usual liver biopsy position.展开更多
Chronic hepatitis B(CHB)infection is a major public health problem associated with significant morbidity and mortality worldwide.Twenty-three percent of patients with CHB progress naturally to liver cirrhosis,which wa...Chronic hepatitis B(CHB)infection is a major public health problem associated with significant morbidity and mortality worldwide.Twenty-three percent of patients with CHB progress naturally to liver cirrhosis,which was earlier thought to be irreversible.However,it is now known that cirrhosis can in fact be reversed by treatment with oral anti-nucleotide drugs.Thus,early and accurate diagnosis of cirrhosis is important to allow an appropriate treatment strategy to be chosen and to predict the prognosis of patients with CHB.Liver biopsy is the reference standard for assessment of liver fibrosis.However,the method is invasive,and is associated with pain and complications that can be fatal.In addition,intra-and inter-observer variability compromises the accuracy of liver biopsy data.Only small tissue samples are obtained and fibrosis is heterogeneous in such samples.This confounds the two types of observer variability mentioned above.Such limitations have encouraged development of non-invasive methods for assessment of fibrosis.These include measurements of serum biomarkers of fibrosis;and assessment of liver stiffness via transient elastography,acoustic radiation force impulse imaging,real-time elastography,or magnetic resonance elastography.Although significant advances have been made,most work to date has addressed the diagnostic utility of these techniques in the context of cirrhosis caused by chronic hepatitis C infection.In the present review,we examine the advantages afforded by use of non-invasive methods to diagnose cirrhosis in patients with CHB infections and the utility of such methods in clinical practice.展开更多
目的通过分析血清高尔基体蛋白73（Golgi protein 73,GP73）及3种常用纤维化评分（Fibrotest、APRI、S指数）无创评估慢性乙型肝炎患者显著肝纤维化的临床价值,探索新的肝纤维化无创诊断指标。方法选取2013年3月-2014年6月经肝活检证实...目的通过分析血清高尔基体蛋白73（Golgi protein 73,GP73）及3种常用纤维化评分（Fibrotest、APRI、S指数）无创评估慢性乙型肝炎患者显著肝纤维化的临床价值,探索新的肝纤维化无创诊断指标。方法选取2013年3月-2014年6月经肝活检证实的慢性乙型肝炎患者148例,检测所有患者血清GP73和其他实验室指标,计算Fibrotest、APRI、S指数等3种评分,所有患者肝脏纤维化程度按Scheuer系统标准分为轻度肝纤维化组80例（S0-S1）,显著肝纤维化组68例（S2-S4）,比较两组患者血清GP73及3种纤维化评分的差异,并采用ROC曲线评价血清GP73及3种纤维化评分单项及联合应用对显著肝纤维化的诊断价值。结果显著肝纤维化组患者的血清GP73及3种纤维化评分均显著高于轻度肝纤维化组患者,差异有统计学意义（P〈0.01）,且血清GP73与肝脏纤维化程度、Fibrotest、APRI、S指数均有较好的相关性;血清GP73、Fibrotest、APRI、S指数诊断显著肝纤维的ROC曲线下面积（AUC）分别为0.750、0.743、0.665、0.661,95%CI分别为0.672-0.817、0.665-0.812、0.583-0.740、0.579-0.737;单项指标中血清GP73的诊断价值最好,AUC达到0.750,以108ng/ml为截点,其预测的敏感性和特异性分别为67.60%和80.00%;对血清GP73及3种常用纤维化评分评分进行多因素logistic回归分析构建联合预测模型,其AUC达到0.813。结论血清GP73对慢性乙型肝炎患者明显肝纤维化的预测有一定的临床应用价值,与其他无创诊断指标联合应用可以提高预测的准确性。展开更多
基金Supported by A grant of the Universidad Nacional Autonoma de Mexico SDI.PTID.05.6
文摘AIM:To assess the usefulness of FibroTest to forecast scores by constructing decision trees in patients with chronic hepatitis C.METHODS:We used the C4.5 classification algorithm to construct decision trees with data from 261 patients with chronic hepatitis C without a liver biopsy.The FibroTest attributes of age,gender,bilirubin,apolipoprotein,haptoglobin,α2 macroglobulin,and γ-glutamyl transpeptidase were used as predictors,and the FibroTest score as the target.For testing,a 10-fold cross validation was used.RESULTS:The overall classification error was 14.9%(accuracy 85.1%).FibroTest's cases with true scores of F0 and F4 were classified with very high accuracy(18/20 for F0,9/9 for F0-1 and 92/96 for F4) and the largest confusion centered on F3.The algorithm produced a set of compound rules out of the ten classification trees and was used to classify the 261 patients.The rules for the classification of patients in F0 and F4 were effective in more than 75% of the cases in which they were tested.CONCLUSION:The recognition of clinical subgroups should help to enhance our ability to assess differences in fibrosis scores in clinical studies and improve our understanding of fibrosis progression.
文摘AIM: To investigate the liver stiffness measurement (LSM) applicability and variability with reference to three probe positions according to the region of liver biopsy. METHODS: The applicability for LSM was defined as at least 10 valid measurements with a success rate greater than 60% and an interquartile range/median LSM < 30%. The LSM variability compared the inter-position concordance and the concordance with FibroTest. RESULTS: Four hundred and forty two consecutive patients were included. The applicability of the anterior position (81%) was significantly higher than that of the reference (69%) and lower positions (68%), (both P = 0.0001). There was a signif icant difference (0.5 kPa, 95% CI 0.13-0.89; P < 0.0001) between mean LSM estimated at the reference position (9.3 kPa) vs the anterior position (8.8 kPa). Discordance between positions was associated with thoracic fold (P = 0.008). The discordance rate between the reference position result and FibroTest was higher when the 7.1 kPa cutoff was used to define advanced fibrosis instead of 8.8 kPa (33.6% vs 23.5%, P = 0.03).CONCLUSION: The anterior position of the probe should be the fi rst choice for LSM using Fibroscan, as it has a higher applicability without higher variability compared to the usual liver biopsy position.
基金Supported by A grant of the South Korea Healthcare technology R and D projectMinistry of Health and Welfare+1 种基金South KoreaNo.HI10C2020
文摘Chronic hepatitis B(CHB)infection is a major public health problem associated with significant morbidity and mortality worldwide.Twenty-three percent of patients with CHB progress naturally to liver cirrhosis,which was earlier thought to be irreversible.However,it is now known that cirrhosis can in fact be reversed by treatment with oral anti-nucleotide drugs.Thus,early and accurate diagnosis of cirrhosis is important to allow an appropriate treatment strategy to be chosen and to predict the prognosis of patients with CHB.Liver biopsy is the reference standard for assessment of liver fibrosis.However,the method is invasive,and is associated with pain and complications that can be fatal.In addition,intra-and inter-observer variability compromises the accuracy of liver biopsy data.Only small tissue samples are obtained and fibrosis is heterogeneous in such samples.This confounds the two types of observer variability mentioned above.Such limitations have encouraged development of non-invasive methods for assessment of fibrosis.These include measurements of serum biomarkers of fibrosis;and assessment of liver stiffness via transient elastography,acoustic radiation force impulse imaging,real-time elastography,or magnetic resonance elastography.Although significant advances have been made,most work to date has addressed the diagnostic utility of these techniques in the context of cirrhosis caused by chronic hepatitis C infection.In the present review,we examine the advantages afforded by use of non-invasive methods to diagnose cirrhosis in patients with CHB infections and the utility of such methods in clinical practice.
文摘目的通过分析血清高尔基体蛋白73（Golgi protein 73,GP73）及3种常用纤维化评分（Fibrotest、APRI、S指数）无创评估慢性乙型肝炎患者显著肝纤维化的临床价值,探索新的肝纤维化无创诊断指标。方法选取2013年3月-2014年6月经肝活检证实的慢性乙型肝炎患者148例,检测所有患者血清GP73和其他实验室指标,计算Fibrotest、APRI、S指数等3种评分,所有患者肝脏纤维化程度按Scheuer系统标准分为轻度肝纤维化组80例（S0-S1）,显著肝纤维化组68例（S2-S4）,比较两组患者血清GP73及3种纤维化评分的差异,并采用ROC曲线评价血清GP73及3种纤维化评分单项及联合应用对显著肝纤维化的诊断价值。结果显著肝纤维化组患者的血清GP73及3种纤维化评分均显著高于轻度肝纤维化组患者,差异有统计学意义（P〈0.01）,且血清GP73与肝脏纤维化程度、Fibrotest、APRI、S指数均有较好的相关性;血清GP73、Fibrotest、APRI、S指数诊断显著肝纤维的ROC曲线下面积（AUC）分别为0.750、0.743、0.665、0.661,95%CI分别为0.672-0.817、0.665-0.812、0.583-0.740、0.579-0.737;单项指标中血清GP73的诊断价值最好,AUC达到0.750,以108ng/ml为截点,其预测的敏感性和特异性分别为67.60%和80.00%;对血清GP73及3种常用纤维化评分评分进行多因素logistic回归分析构建联合预测模型,其AUC达到0.813。结论血清GP73对慢性乙型肝炎患者明显肝纤维化的预测有一定的临床应用价值,与其他无创诊断指标联合应用可以提高预测的准确性。
