Fibrosis Staging Using Direct Serum Biomarkers is Influenced by Hepatitis Activity Grading in Hepatitis C Virus Infection
Fibrosis Staging Using Direct Serum Biomarkers is Influenced by Hepatitis Activity Grading in Hepatitis C Virus Infection
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DOI：
10.3390/jcm7090267
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发表时间：
2018-09-01
影响因子：
3.9
通讯作者：
Masaki, Tsutomu
中科院分区：
文献类型：
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作者：
Fujita, Koji;Kuroda, Noriyuki;Masaki, Tsutomu
背景：慢性肝病（CLDs）通常从炎症发展到纤维化，最后发展到癌变。肝纤维化进展的分期对于CLD患者的管理是不可避免的。本研究的目的是比较紫藤凝集素阳性Mac-2结合蛋白（WFA-M2 BP）、增强型肝纤维化（ELF）评分、纤维化-4指数和AST与血小板比率指数（APRI）的诊断能力，这些诊断能力基于对丙型肝炎病毒（HCV）感染阳性患者肝活检样本的组织病理学分析。方法：本研究招募了接受肝活检检查的日本丙型肝炎病毒感染患者。使用保存的血清样品计算WFA-M2 BP水平和ELF评分。使用改良的METAVIR评分评估纤维化分期和活动分级。结果如下：共入组122例患者;该队列包括27例1期纤维化患者，66例2期纤维化患者，20例3期纤维化患者和9例4期纤维化患者。所有四种生物标志物区分3期和2期纤维化。ROC曲线显示，所有四种纤维化生物标志物的AUC值均大于0.8。第2阶段中的四种生物标志物中的每一种在活动等级1和2组之间均显著不同。结论：Fib-4指数和APRI与WFA-M2 BP和ELF评分在诊断日本HCV感染患者晚期肝纤维化方面具有可比性。肝纤维化的四种生物标志物均受到组织病理学活动分级的影响，这意味着肝活检应该是评估肝纤维化分期的金标准，即使一些非侵入性生物标志物已经研究得很好。
Background: Chronic liver diseases (CLDs) generally progress from inflammation to fibrosis and finally to carcinogenesis. Staging of liver fibrosis progression is inevitable for the management of CLD patients. The purpose of this study was to compare the diagnostic abilities of Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA-M2BP), Enhanced liver fibrosis (ELF) score, Fibrosis-4 index, and AST to platelet ratio index (APRI) based on histopathological analysis of liver biopsy samples, from patients with positive Hepatitis C Virus (HCV) infection. Methods: Japanese patients with HCV infection who underwent liver biopsy examinations were enrolled in this study. WFA-M2BP levels and ELF scores were calculated using preserved serum samples. The fibrosis staging and activity grading were assessed using a modified METAVIR score. Results: A total of 122 patients were enrolled; the cohort included 27 patients with stage 1, 66 with stage 2, 20 with stage 3, and nine with stage 4 fibrosis. All four biomarkers distinguished stage 3 and stage 2 fibrosis. ROC curves revealed that all four fibrosis biomarkers presented AUC values greater than 0.8. Each of the four biomarkers in stage 2 was significantly different between the activity grade 1 and 2 groups. Conclusion: Fib-4 index and APRI were comparable with WFA-M2BP and ELF score in the diagnosis of advanced liver fibrosis in Japanese patients with HCV infection. All four biomarkers of liver fibrosis were influenced by histopathological activity grading, which implies that liver biopsy should be the gold standard to evaluate liver fibrosis staging even though several noninvasive biomarkers have been investigated well.