Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay.
Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay.
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DOI：
10.1002/hep.22517
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发表时间：
2008-11
期刊：
影响因子：
13.5
通讯作者：
Rosenberg, William M.
中科院分区：
文献类型：
--
作者：
Mayo, Marlyn J.;Parkes, Julie;Adams-Huet, Beverley;Combes, Burton;Mills, A. S.;Markin, Rodney S.;Rubin, Raphael;Wheeler, Donald;Contos, Melissa;West, A. B.;Saldana, Sandra;Getachew, Yoflas;Butsch, Robert;Luketic, Velimir;Peters, Marion;Di Bisceglie, Adrian;Bass, Nathan;Lake, John;Boyer, Thomas;Martinez, Enrique;Boyer, James;Garcia-Tsao, Guadalupe;Barnes, David;Rosenberg, William M.
原发性胆汁性肝硬化（PBC）有时是根据抗线粒体抗体阳性诊断，在适当的临床设置，没有肝活检。虽然肝活检可以评估肝纤维化程度并提供预后信息，但血清纤维化标志物避免了活检并发症、采样误差，并作为连续变量提供结果，这可能比分类组织学分期更精确。目前的研究旨在评估血清纤维化标志物作为PBC患者临床进展的预测指标。161例PBC患者每2年收集一次肝活检和血清样本，中位时间为7.3年。临床进展定义为出现以下一个或多个事件：静脉曲张、静脉曲张出血、腹水、脑病、肝移植或肝脏相关死亡。测定血清HA、TIMP-1和PIIINP，并将其输入先前验证的Enhanced Liver Fibrosis （ELF）算法。在不同的时间点评估ELF、组织学纤维化、胆红素、MELD和Mayo风险评分区分会经历临床事件的个体和不会经历临床事件的个体的能力。基线ELF高的患者无事件生存率显著降低。ELF每增加1分，未来并发症增加3倍。在接近第一次事件发生时间时，所有测试的预后表现相似。然而，在疾病过程的早期（首次事件发生前4年和6年），ELF的预后表现明显优于MELD或Mayo R评分。ELF算法是一种高度准确的PBC疾病严重程度的非侵入性测量方法，可提供有用的长期预后信息。
Primary biliary cirrhosis (PBC) is sometimes diagnosed based upon a positive antimitochondrial antibody in the appropriate clinical setting without a liver biopsy. While a liver biopsy can assess the extent of liver fibrosis and provide prognostic information, serum fibrosis markers avoid biopsy complications, sampling error, and provide results as a continuous variable, which may be more precise than categorical histological stages. The current study was undertaken to evaluate serum fibrosis markers as predictors of clinical progression in a large cohort of PBC patients. Serial liver biopsies and serum samples were collected every 2 years in 161 PBC subjects for a median of 7.3 years. Clinical progression was defined as development of one or more of the following events: varices, variceal bleed, ascites, encephalopathy, liver transplant, or liver-related death. Serum HA, TIMP-1, and PIIINP were measured and entered into the previously validated Enhanced Liver Fibrosis (ELF) algorithm. The ability of ELF, histological fibrosis, bilirubin, MELD, and Mayo Risk Score to differentiate between individuals who would experience a clinical event from those who would not was evaluated at different time points. Event-free survival was significantly lower in those with high baseline ELF. Each 1 point increase in ELF was associated with a 3 fold increase in future complications. The prognostic performance of all tests was similar when performed close to the time of the first event. However, at earlier times in the disease process (4 and 6 years prior to the first event), the prognostic performance of ELF was significantly better than MELD or Mayo R score. The ELF algorithm is a highly accurate non-invasive measure of PBC disease severity which provides useful long-term prognostic information.
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