Performance of the Aspartate Aminotransferase-to-Platelet Ratio Index for the Staging of Hepatitis C-Related Fibrosis: An Updated Meta-Analysis
Performance of the Aspartate Aminotransferase-to-Platelet Ratio Index for the Staging of Hepatitis C-Related Fibrosis: An Updated Meta-Analysis
复制标题
DOI：
10.1002/hep.24105
复制
发表时间：
2011-03-01
期刊：
影响因子：
13.5
通讯作者：
Xuan, Shi-Ying
中科院分区：
文献类型：
--
作者：
Lin, Zhong-Hua;Xin, Yong-Ning;Xuan, Shi-Ying
天冬氨酸转氨酶与血小板比率指数（APRI）是一种费用有限且广泛可用的工具，是检测肝纤维化的一种有前途的非侵入性肝活检替代方法。本研究的目的是更新2007年的荟萃分析，以系统地评估APRI在预测丙型肝炎病毒（HCV）单感染和HCV/人类免疫缺陷病毒（HIV）合并感染个体的显著纤维化，严重纤维化和肝硬化阶段的准确性。通过全面的文献检索确定了在HCV患者中比较APRI与活检的研究。受试者工作特征曲线下面积（AUROC）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）用于检查APRI诊断显著纤维化、严重纤维化和肝硬化的准确性。使用荟萃回归探索异质性。另有21项研究符合更新条件，本次综述共纳入40项研究（n = 8，739）。APRI诊断显著纤维化、重度纤维化和肝硬化的汇总AUROC分别为0.77、0.80和0.83。对于严重纤维化，APRI阈值0.7的敏感性为77%，特异性为72%。对于严重纤维化，阈值1.0的敏感性为61%，特异性为64%。对于肝硬化，阈值为1.0的敏感性为76%，特异性为72%。此外，我们发现APRI在HIV/HCV合并感染患者中识别显著纤维化、严重纤维化和肝硬化的准确性较低。结论：我们的大型荟萃分析表明，APRI可以识别丙型肝炎相关纤维化，具有中等程度的准确性。该指数的应用可能会减少对慢性丙型肝炎患者肝活检标本进行分期的需要。（肝脏学2011;53：726-736）
The aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to update the 2007 meta-analysis to systematically assess the accuracy of APRI in predicting significant fibrosis, severe fibrosis, and cirrhosis stage in hepatitis C virus (HCV) monoinfected and HCV/human immunodeficiency virus (HIV) coinfected individuals. Studies comparing APRI versus biopsy in HCV patients were identified via a thorough literature search. Areas under summary receiver operating characteristic curves (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to examine the APRI accuracy for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis. Heterogeneity was explored using meta-regression. Twenty-one additional studies were eligible for the update and, in total, 40 studies were included in this review (n = 8,739). The summary AUROC of the APRI for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis were 0.77, 0.80, and 0.83, respectively. For significant fibrosis, an APRI threshold of 0.7 was 77% sensitive and 72% specific. For severe fibrosis, a threshold of 1.0 was 61% sensitive and 64% specific. For cirrhosis, a threshold of 1.0 was 76% sensitive and 72% specific. Moreover, we found that the APRI was less accurate for the identification of significant fibrosis, severe fibrosis, and cirrhosis in HIV/HCV coinfected patients. Conclusion: Our large meta-analysis suggests that APRI can identify hepatitis C-related fibrosis with a moderate degree of accuracy. Application of this index may decrease the need for staging liver biopsy specimens among chronic hepatitis C patients. (HEPATOLOGY 2011;53:726-736)