The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa.
The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa.
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DOI：
10.1136/gutjnl-2015-309260
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发表时间：
2016-08
期刊：
影响因子：
24.5
通讯作者：
Thursz M
中科院分区：
文献类型：
--
作者：
Lemoine M;Shimakawa Y;Nayagam S;Khalil M;Suso P;Lloyd J;Goldin R;Njai HF;Ndow G;Taal M;Cooke G;D'Alessandro U;Vray M;Mbaye PS;Njie R;Mallet V;Thursz M
非常需要简单和廉价的非侵入性纤维化测试，但在撒哈拉以南非洲研究得很差。以肝组织学为金标准，我们开发了一种新的指数，使用常规实验室检查来预测西非冈比亚慢性HBV感染患者的显著纤维化。我们前瞻性地评估了冈比亚CHB患者（训练集）以及法国和塞内加尔CHB队列（验证集）中新指数Fibroscan、天冬氨酸转氨酶与血小板比率指数（APRI）和Fib-4的诊断准确性。在135例接受肝活检的连续未经治疗的CHB患者中，39%有显著的纤维化（Metavir纤维化分期≥F2），15%有肝硬化（F4）。在多变量分析中，γ-谷氨酰转肽酶（GGT）和血小板计数是显著纤维化的独立预测因子。因此，开发了GGT与血小板比率（GPR）。在冈比亚，GPR的受试者工作特征曲线下面积（AUROC）显著高于APRI和Fib-4，以预测≥F2、≥F3和F4。在塞内加尔，对于≥F2，GPR的AUROC显著优于Fib-4和APRI（0.73，95% CI 0.59至0.86），对于≥F3，GPR的AUROC显著优于Fib-4和Fibroscan（0.93，0.87至0.99）。在法国，GPR诊断≥F2（0.72，95% CI 0.59 - 0.85）和F4（0.87，0.76 - 0.98）的AUROC与APRI和Fib-4相当。GPR是一种比APRI和Fib-4更准确的常规实验室标记物，用于对西非CHB患者的肝纤维化进行分期。在撒哈拉以南非洲地区，GPR是肝活检和Fibroscan的一种简单而廉价的替代方案。
Simple and inexpensive non-invasive fibrosis tests are highly needed but have been poorly studied in sub-Saharan Africa. Using liver histology as a gold standard, we developed a novel index using routine laboratory tests to predict significant fibrosis in patients with chronic HBV infection in The Gambia, West Africa. We prospectively assessed the diagnostic accuracy of the novel index, Fibroscan, aspartate transaminase-to-platelet ratio index (APRI), and Fib-4 in Gambian patients with CHB (training set) and also in French and Senegalese CHB cohorts (validation sets). Of 135 consecutive treatment-naïve patients with CHB who had liver biopsy, 39% had significant fibrosis (Metavir fibrosis stage ≥F2) and 15% had cirrhosis (F4). In multivariable analysis, gamma-glutamyl transpeptidase (GGT) and platelet count were independent predictors of significant fibrosis. Consequently, GGT-to-platelet ratio (GPR) was developed. In The Gambia, the area under the receiver operating characteristic curve (AUROC) of the GPR was significantly higher than that of APRI and Fib-4 to predict ≥F2, ≥F3 and F4. In Senegal, the AUROC of GPR was significantly better than Fib-4 and APRI for ≥F2 (0.73, 95% CI 0.59 to 0.86) and better than Fib-4 and Fibroscan for ≥F3 (0.93, 0.87 to 0.99). In France, the AUROC of GPR to diagnose ≥F2 (0.72, 95% CI 0.59 to 0.85) and F4 (0.87, 0.76 to 0.98) was equivalent to that of APRI and Fib-4. The GPR is a more accurate routine laboratory marker than APRI and Fib-4 to stage liver fibrosis in patients with CHB in West Africa. The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa.