Noninvasive inflammatory markers for assessing liver fibrosis stage in autoimmune hepatitis patients
Noninvasive inflammatory markers for assessing liver fibrosis stage in autoimmune hepatitis patients
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DOI：
10.1097/meg.0000000000001437
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发表时间：
2019-11-01
影响因子：
2.1
通讯作者：
Zhang, Lanjing
中科院分区：
文献类型：
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作者：
Yuan, Xiaoling;Duan, Sheng-Zhong;Zhang, Lanjing
目的探讨非侵入性炎症标志物预测自身免疫性肝炎（AIH）患者肝纤维化分期的准确性。患者和方法本研究纳入55例AIH患者和60例健康对照者，将其分为3组：F0组（对照组）；F1-F3（非肝硬化纤维化）；F4（肝硬化）。分析所有参与者的以下指标：淋巴细胞与中性粒细胞比率（LNR）；淋巴细胞血小板比；淋巴细胞/单核细胞比值；免疫球蛋白血小板比；血小板转氨酶比值指数；谷草转氨酶与丙氨酸转氨酶比值（AAR）；纤维化-4评分（FIB-4）。使用受试者工作特征曲线下的面积来评估这些无创标记物的预测准确性。多变量有序逻辑回归模型用于分析无创标志物与肝纤维化分期之间的关系。结果AAR、LPR、LMR、IGPR、APRI、FIB-4与肝纤维化分期相关（P < 0.05），相关指数分别为- 0.219、0.258、- 0.149、0.647、0.841、0.704，与LNR无关（P = 0.093）。LPR、IGPR、AAR、LMR、APRI、FIB-4检测肝硬化（F4 vs F0-F3）的受试者工作特征曲线下面积分别为0.936（95%可信区间0.870-1.000,P < 0.001）、0.939 （0.875-1.000,P < 0.001）、0.528 （0.319-0.738,P = 0.768）、0.555 （0.409-0.700,P = 0.568）、0.798 （0.694-0.902,P = 0.002）、0.881 （0.796-0.967,P < 0.001）。多变量有序回归分析显示，LPR、IGPR与肝纤维化分期独立相关，相关系数分别为0.385（95%可信区间：0.103 ~ 0.667,P = 0.007）、14.903（95%可信区间：2.091 ~ 27.786,P = 0.023）。结论LPR和IGPR与AIH治疗初期肝纤维化分期独立相关，且在检测肝硬化方面优于APRI和FIB-4。
Objective To examine the accuracy of noninvasive inflammatory markers in predicting liver fibrosis stage in patients with autoimmune hepatitis (AIH). Patients and methods We enrolled 55 patients with AIH and 60 healthy controls in this study, and divided them into three groups: F0 (control); F1-F3 (noncirrhotic fibrosis); and F4 (cirrhosis). The following markers were analyzed for all participants: lymphocyte-to-neutrophil ratio (LNR); lymphocyte-to-platelet ratio (LPR); lymphocyte-to-monocyte ratio (LMR); immunoglobulin-to-platelet ratio (IGPR); aminotransferase-to-platelet ratio index (APRI); aspartate aminotransferase-to-alanine aminotransferase ratio (AAR); and fibrosis-4 score (FIB-4). The predictive accuracy of these noninvasive markers was assessed using area under the receiver operating characteristic curve. Multivariate ordinal logistic regression models were used to analyze associations between the noninvasive markers and liver fibrosis stage. Results AAR, LPR, LMR, IGPR, APRI, and FIB-4 were linked to liver fibrosis-stage (P < 0.05), with correlation indices of - 0.219, 0.258, - 0.149, 0.647, 0.841, and 0.704, respectively, but not LNR (P = 0.093). area under the receiver operating characteristic curves of LPR, IGPR, AAR, LMR, APRI, and FIB-4 for detecting cirrhosis (F4 vs. F0-F3) were 0.936 (95% confidence interval: 0.870-1.000, P < 0.001), 0.939 (0.875-1.000, P < 0.001), 0.528 (0.319-0.738, P = 0.768), 0.555 (0.409-0.700, P = 0.568), 0.798 (0.694-0.902, P = 0.002), and 0.881 (0.796-0.967, P < 0.001). Our multivariate ordinal regression analysis showed that LPR and IGPR were associated independently with liver fibrosis stage, with a coefficient of 0.385 (95% confidence interval: 0.103-0.667, P = 0.007) and 14.903 (2.091-27.786, P = 0.023), respectively. Conclusion LPR and IGPR were associated independently with liver fibrosis stage in treatment-naive AIH, and were superior to APRI and FIB-4 in detecting cirrhosis.