Staging chronic hepatitis C in seven categories using fibrosis biomarker (FibroTest™) and transient elastography (FibroScan®)
Staging chronic hepatitis C in seven categories using fibrosis biomarker (FibroTest™) and transient elastography (FibroScan®)
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DOI：
10.1016/j.jhep.2013.11.016
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发表时间：
2014-04-01
影响因子：
25.7
通讯作者：
de Ledinghen, Victor
中科院分区：
文献类型：
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作者：
Poynard, Thierry;Vergniol, Julien;de Ledinghen, Victor
背景和目标：FibroTest（TM）（FT）和瞬时弹性成像（TE）已被验证为使用活检的从F0到F4的META-VIR纤维化阶段的非侵入性标志物，并且作为慢性丙型肝炎患者的肝脏相关死亡率的预后标志物。目的是扩展FT和TE作为无并发症肝硬化发生定义的关键步骤标志物的有效性（F4.1），食管静脉曲张（F4.2）和严重并发症（F4.3）：原发性肝癌、静脉曲张出血或失代偿（腹水、脑病或黄疸）。方法：3927例患者的更新个体数据在基线时没有并发症的1046例患者从称为“EPIC”、“巴黎”和“波尔多”的三个前瞻性队列中汇总。5年时，在501例基线（F4.1）无静脉曲张的患者中，19例患者发生静脉曲张[F4.2发生率为4.0%（95% CI 2.2-5.8）]。FT的预测性能（AUROC）为0.77（0.66-0.84; p < 0.001）。10年时，203例患者发生严重并发症[F4.3发生率为13.4%（9.6-17.1）]，包括84例患者发生原发性肝癌[6.4%（3.5-9.3）]。FT可预测严重并发症[AUROC 0.79（76-82）; p < 0.0001]，包括原发性肝癌[AUROC 0.84（80-87）; p < 0.0001]（根据治疗调整考克斯）。类似地，TE预测严重并发症[AUROC 0.77（72-81）; p < 0.0001]，包括原发性肝癌[AUROC 0.86（81-90）; p < 0.0001]。结论：FibroTest（TM）和TE增加与所有严重并发症的发生相关，包括肝细胞癌、肝功能不全和静脉曲张出血。FibroTest（TM）的增加也与食管静脉曲张的发生有关。(C)2013年欧洲肝脏研究协会。由Elsevier B出版。版权所有© 2016
Background & Aims: FibroTest (TM) (FT) and Transient Elastography (TE) have been validated as non-invasive markers of META-VIR fibrosis stages from F0 to F4 using biopsy, and as prognostic markers of liver related mortality in patients with chronic hepatitis C. The aim was to extend the validation of FT and TE as markers of critical steps defined by occurrence of cirrhosis without complications (F4.1), esophageal varices (F4.2), and severe complications (F4.3): primary liver cancer, variceal bleeding, or decompensation (ascites, encephalopathy, or jaundice).Methods: The updated individual data of 3927 patients (1046 cirrhotics) without complications at baseline were pooled from three prospective cohorts called "EPIC", "Paris", and "Bordeaux" cohorts.Results: At 5 years, among 501 patients without varices at baseline (F4.1) varices occurred in 19 patients [F4.2 incidence of 4.0% (95% CI 2.2-5.8)]. The predictive performance (AUROC) of FT was 0.77 (0.66-0.84; p < 0.001). At 10 years severe complications occurred in 203 patients, [F4.3 incidence of 13.4% (9.6-17.1)], including primary liver cancer in 84 patients [6.4% (3.5-9.3)]. FT was predictive (Cox adjusted on treatment) of severe complications [AUROC 0.79 (76-82); p < 0.0001], including primary liver cancer [AUROC 0.84 (80-87); p < 0.0001]. Similarly TE was predictive of severe complications [AUROC 0.77 (72-81); p < 0.0001], including primary liver cancer [AUROC 0.86 (81-90); p < 0.0001].Conclusions: FibroTest (TM) and TE increase were associated with the occurrence of all severe complications including hepatocellular carcinoma, hepatic insufficiency, and variceal bleeding. FibroTest (TM) increase was also associated with the occurrence of esophageal varices. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.