Prospective comparison of transient elastography, fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C
Prospective comparison of transient elastography, fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C
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DOI：
10.1053/j.gastro.2004.11.018
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发表时间：
2005-02-01
期刊：
影响因子：
29.4
通讯作者：
De Lédinghen, V
中科院分区：
文献类型：
--
作者：
Castéra, L;Vergniol, J;De Lédinghen, V
背景和目标：瞬时弹性成像（FibroScan; Echosens，巴黎，法国）是一种通过测量肝硬度来评估肝纤维化的新型、无创、快速床旁方法。我们前瞻性地评估了FibroScan在慢性丙型肝炎患者中的性能，并与目前可用的生化标志物（Fibrotest; Biopreditive;和天冬氨酸转氨酶与血小板比率指数[APRI]）进行比较和组合;同一天进行的肝活检检查作为参考。方法：我们研究了183例连续的慢性丙型肝炎患者（METAVIR纤维化分期F1，n = 47; F2，n = 53; F3，n = 37; F4，n = 46）。结果：FibroScan值范围为2.4至75.4千帕（中位数为7.4千帕）。对于F大于或等于2，截止值为7.1 kPa，对于F大于或等于3，截止值为9.5 kPa，对于F = 4，截止值为12.5 kPa。FibroScan、FibroTest和APRI值的受试者工作特征（ROC）曲线下面积具有相同的数量级（对于F大于或等于2，分别为0.83、0.85和0.78;对于F大于或等于3，分别为0.90、0.90和0.84;对于F = 4，分别为0.95、0.87和0.83）。通过组合FibroScan和FibroTest获得了最佳性能，F大于或等于2时ROC曲线下面积为0.88，F大于或等于3时为0.95，F = 4时为0.95。当FibroScan和FibroTest结果一致时，肝活检检查证实了84%的F大于或等于2的病例，95%的F大于或等于3，94%的F = 4。结论：FibroScan是一种简单有效的评估肝纤维化的方法，其性能与FibroTest和APRI相似。联合使用FibroScan和FibroTest评估肝纤维化可以避免大多数慢性丙型肝炎患者的活检程序。
Background & Aims: Transient elastography (FibroScan; Echosens, Paris, France) is a novel, noninvasive, and rapid bedside method to assess liver fibrosis by measuring liver stiffness. We prospectively assessed the performance of FibroScan in patients with chronic hepatitis C, in comparison with and combined with currently available biochemical markers (Fibrotest; Biopredictive; and the aspartate transaminase to platelets ratio index [APRI]); a liver biopsy examination performed the same day served as the reference. Methods: We studied 183 consecutive patients with chronic hepatitis C (METAVIR fibrosis stage F1, n = 47; F2, n = 53; F3, n = 37; F4, n = 46). Results: FibroScan values ranged from 2.4 to 75.4 kilopascals (median, 7.4 kilopascals). Cut-off values were 7.1 kPa for F greater than or equal to 2, 9.5 kPa for F greater than or equal to 3, and 12.5 kPa for F = 4. The areas under the receiver operating characteristic (ROC) curve of FibroScan, FibroTest, and APRI values were of the same order (.83,.85, and .78, respectively, for F greater than or equal to 2; .90, .90, and .84, respectively, for F greater than or equal to 3; and .95, .87, and .83, respectively, for F = 4). The best performance was obtained by combining the FibroScan and FibroTest, with areas under the ROC curve of .88 for F greater than or equal to 2,.95 for F greater than or equal to 3, and .95 for F = 4. When the FibroScan and FibroTest results agreed, liver biopsy examination confirmed them in 84% of cases for F greater than or equal to 2, in 95% for F greater than or equal to 3, and in 94% for F = 4. Conclusions: FibroScan is a simple and effective method for assessing liver fibrosis, with similar performance to FibroTest and APRI. The combined use of FibroScan and FibroTest to evaluate liver fibrosis could avoid a biopsy procedure in most patients with chronic hepatitis C.