Improving noninvasive methods of assessing liver fibrosis in patients with hepatitis C virus/human immunodeficiency virus co-infection.
Improving noninvasive methods of assessing liver fibrosis in patients with hepatitis C virus/human immunodeficiency virus co-infection.
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DOI：
10.1016/j.cgh.2008.12.016
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发表时间：
2009-04
期刊：
影响因子：
--
通讯作者：
AIDS Clinical Trials Group 5178 Study Group
中科院分区：
文献类型：
--
作者：
Shire NJ;Rao MB;Succop P;Buncher CR;Andersen JA;Butt AA;Chung RT;Sherman KE;AIDS Clinical Trials Group 5178 Study Group
肝纤维化是丙型肝炎病毒（HCV）/HIV合并感染患者的一个重要问题。纤维化分期活检是准确的，但昂贵和侵入性。已经开发了几种利用非侵入性生物标志物的纤维化预测模型，但在合并感染患者中是次优的。我们比较了不同分期模型和有序回归与活检数据的结果。来自成人艾滋病临床试验组方案A5178的数据用于评估5种纤维化分期模型;评估受试者-操作者特征曲线下面积（AUROC）。用单变量回归评估个体协变量，然后进入有序逻辑回归模型，从中开发阶段指数。对173例患者的数据进行了评估; 85%的患者接受抗逆转录病毒治疗，31.2%的患者患有严重纤维化（F3/F4），14%的患者患有肝硬化（F4）。在有和没有F3/F4的患者之间观察到CD 4+细胞和血小板计数以及国际标准化比值的差异。在现有模型中，FIB-4指数表现最好，F4的特异性为88%，F3/F4的阴性预测值>86%，尽管AUROC值较低（F3/F4为0.56±0.03）。使用患者的人口统计学、临床和实验室数据，有序回归模型优于其他模型，AUROC = 0.85（SE 0.03）预测F3/F4期，AUROC = 0.89（SE 0.05）预测单独的3期。目前的非侵入性纤维化评估方法在HCV/HIV合并感染患者中的区分能力较差。有序回归分析优于其他非侵入性纤维化预测模型。配对活检的纵向研究将有助于改进有序回归指数。
Liver fibrosis is a significant concern for patients with hepatitis C virus (HCV)/HIV co-infection. Fibrosis staging by biopsy is accurate but costly and invasive. Several fibrosis prediction models utilizing non-invasive biomarkers have been developed but are suboptimal in co-infected patients. We compared results from different staging models and ordinal regression with biopsy data. Data from the Adult AIDS Clinical Trials Group protocol A5178 were used to evaluate 5 models of fibrosis staging; areas under receiver-operator characteristic curves (AUROC) were assessed. Individual covariates were assessed with univariable regression then entered into an ordinal logistic regression model from which a stage-wise index was developed. Data from 173 patients were evaluated; 85% were on anti-retroviral therapy, 31.2% had severe fibrosis (F3/F4) and 14% had cirrhosis (F4). Differences in CD4+ cell and platelets counts and international normalized ratio values were observed between those with and without F3/F4. Among existing models, the FIB-4 index performed best, with 88% specificity for F4 and >86% negative predictive values for F3/F4, although AUROC values were low (0.56±0.03 for F3/F4). Using patients’ demographic, clinical, and laboratory data, the ordinal regression model outperformed others, with AUROC = 0.85 (SE 0.03) for predicting stage F3/F4 and 0.89 (SE 0.05) for stage 3 alone. Current noninvasive methods of fibrosis assessment have poor discriminatory capacity in HCV/HIV co-infected patients. Ordinal regression analysis outperformed other non-invasive fibrosis prediction models. Longitudinal studies with paired biopsies will assist in refining the ordinal regression index.
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DOI：
10.1186/1476-5926-3-8
发表时间：
2004-09-23
期刊：
Comparative hepatology
影响因子：
--
作者：
Poynard T;Imbert-Bismut F;Munteanu M;Messous D;Myers RP;Thabut D;Ratziu V;Mercadier A;Benhamou Y;Hainque B
通讯作者：
Hainque B
影响因子：
25.7
作者：
Kelleher, TB;Mehta, SH;Afdhal, NH
通讯作者：
Afdhal, NH
影响因子：
3.8
作者：
Myers, RP;Benhamou, Y;Poynard, T
通讯作者：
Poynard, T
影响因子：
9.3
作者：
Rossi, E;Adams, L;Jeffrey, G
通讯作者：
Jeffrey, G
影响因子：
13.5
作者：
Lackner, C;Struber, G;Stauber, RE
通讯作者：
Stauber, RE