Diagnostic value of fibronectin discriminant score for predicting liver fibrosis stages in chronic hepatitis C virus patients
Diagnostic value of fibronectin discriminant score for predicting liver fibrosis stages in chronic hepatitis C virus patients
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DOI：
10.1016/s1665-2681(19)31384-5
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发表时间：
2013-01-01
影响因子：
3.8
通讯作者：
Shaker, Yehia M.
中科院分区：
文献类型：
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作者：
Attallah, Abdelfattah M.;Abdallah, Sanaa O.;Shaker, Yehia M.
背景。开发了几种无创预测模型来替代肝活检来评估纤维化。目的。评估反映细胞外基质代谢的纤连蛋白和反映肝功能变化的标准肝功能测试的诊断价值。材料和方法。使用 ROC 曲线和逐步多元判别分析 (MDA) 对慢性丙型肝炎 (CHC) 患者 (n = 145) 进行评估，并在另外 180 名患者中进行了验证。评估肝脏生化特征，包括转氨酶、胆红素、碱性磷酸酶、白蛋白、全血细胞计数。使用单克隆抗体和 ELISA 测定纤连蛋白浓度。结果。开发了一种基于纤连蛋白、APRI 和白蛋白的新型指数，称为纤连蛋白判别评分（FDS）。 FDS 产生的 ROC 曲线下面积 (AUC) 为 0.91（对于显着纤维化）和 0.81（对于晚期纤维化）。 FDS 正确分类了 79% 的显着肝纤维化患者 (F2-F4)，敏感性为 87%，特异性为 75%。使用通过 ROC 曲线分析确定的截止值，发生显着肝纤维化的相对风险[比值比 (OR)] 纤连蛋白为 6.1，APR! 为 4.9，白蛋白为 4.2。 FDS 预测肝纤维化，显着纤维化的 OR 为 16.8，晚期纤维化的 OR 为 8.6。验证组和估计组的 FDS 具有相似的 AUC 和 OR，无统计学显着差异。结论。 FDS 可以高度准确地预测肝纤维化，从而可能减少所需的肝活检数量。
Background. Several noninvasive predictive models were developed to substitute liver biopsy for fibrosis assessment. Aim. To evaluate the diagnostic value of fibronectin which reflect extracellular matrix metabolism and standard liver functions tests which reflect alterations in hepatic functions. Material and methods. Chronic hepatitis C (CHC) patients (n = 145) were evaluated using ROC curves and stepwise multivariate discriminant analysis (MDA) and was validated in 180 additional patients. Liver biochemical profile including transaminases, bilirubin, alkaline phosphatase, albumin, complete blood count were estimated. Fibronectin concentration was determined using monoclonal antibody and ELISA. Results. A novel index named fibronectin discriminant score (FDS) based on fibronectin, APRI and albumin was developed. FDS produced areas under ROC curves (AUC) of 0.91 for significant fibrosis and 0.81 for advanced fibrosis. The FDS correctly classified 79% of the significant liver fibrosis patients (F2-F4) with 87% sensitivity and 75% specificity. The relative risk [odds ratio (OR)] of having significant liver fibrosis using the cut-off values determined by ROC curve analyses were 6.1 for fibronectin, 4.9 for APR!, and 4.2 for albumin. FDS predicted liver fibrosis with an OR of 16.8 for significant fibrosis and 8.6 for advanced fibrosis. The FDS had similar AUC and OR in the validation group to the estimation group without statistically significant difference. Conclusion. FDS predicted liver fibrosis with high degree of accuracy, potentially decreasing the number of liver biopsy required.