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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Non Invasive Methods versus Liver Biopsyfor Making Therapeutic Decisions in ChronicHepatitis B Patients with High HBV DNALevels and Mildly Elevated Transaminases
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Non Invasive Methods versus Liver Biopsyfor Making Therapeutic Decisions in ChronicHepatitis B Patients with High HBV DNALevels and Mildly Elevated Transaminases

机译：非侵入方法与肝脏活组织检查在于肝炎患者的高HBV DNALEVELS和轻微升高的转氨酶患者进行治疗决策

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Staging of liver fibrosis is essential for making therapeutic decisions in patients with Chronic Hepatitis B (CHB) having raised Hepatitis B Virus Deoxyribonucleic Acid (HBV DNA) levels (>2000 IU/ml) and normal or mildly elevated Alanine Transaminase (ALT). Though the gold standard for assessment of liver fibrosis has been liver biopsy, many non invasive models have been developed to mitigate the risks associated with liver biopsy and overcome its limitations.Aim: To evaluate the non invasive models predictive of significant fibrosis in this selected subgroup of Chronic Hepatitis B patients.Materials and Methods: Fifty-six CHB patients were evaluated. This longitudinal observational study was conducted at Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University from February 2017 to July 2018 on 56 patients. Liver Stiffness Measurement (LSM), Aspartate Aminotransferase (AST)to Platelet Ratio Index (APRI), FIBROSIS-4 (FIB-4) and Gamma-Glutamyl Transpeptidase (GGT) to platelet ratio (GPR) were estimated. Liver fibrosis staging was done using Metavir score. Significant fibrosis corresponds to Metavir score F2-F4 and advanced fibrosis as more than F3.The performance of non invasive methods was assessed using Receiver Operating Characteristic (ROC) curves. Z -test was used to compare Area Under ROC Curves (AUROCs).Results: Twenty-one patients (37.5%) had significant fibrosis, out of which seven had F3-F4 fibrosis. Patients with F2-F4 fibrosis had higher age, Hepatitis B e antigen (HBeAg) positivity, HBV DNA, ALT, AST, GGT, LSM, APRI, FIB-4 and GPR values than patients with F0-F1 fibrosis. Metavir fibrosis stages positively correlated with LSM values (r=0.831, p<0.0001), APRI (r=0.338, p=0.011), FIB-4 (r=0.375, p=0.003) and GPR (r=0.36, p=0.012). To predict advanced fibrosis, the AUROC of LSM had higher AUROC than APRI (0.956 vs 0.755, p=0.01), FIB-4 (0.956vs 0.786, p=0.01) and was comparable to GPR (0.956 vs 0.895, p=0.2).Conclusion: Transient Elastography (TE) is a reliable non invasive test for the diagnosis of liver fibrosis. GPR is a new model which is comparable to APRI and FIB-4 but inferior to TE.
机译：肝纤维化的分期对于使慢性乙型肝炎（CHB）患者的治疗决策是必不可少的，所述乙型肝炎病毒脱氧核糖核酸（HBV DNA）水平（> 2000IU / mL）和正常或温和升高的丙氨酸转氨酶（ALT）。虽然评估肝纤维化的黄金标准已经是肝活检，但已经开发出许多非侵入性模型，以减轻与肝活检相关的风险，并克服其限制：评估该选定的亚组中的非侵入性模型预测显着纤维化慢性乙型肝炎患者。评估五十六个CHB患者。这项纵向观察研究是在2017年2月至2018年7月在56名患者中在Banaras Hindu大学医科院爵士医院Sir Sunderlal医院进行。估计肝硬化测量（LSM），天冬氨酸氨基转移酶（AST）至血小板比指数（AP1），纤维化-4（FIB-4）和γ-谷氨酸转发酶（GGT）血小板比（GPR）。使用Metavir得分完成肝纤维化分段。显着的纤维化对应于Metavir得分F2-F4和高级纤维化，以及超过F3的纤维化。使用接收器操作特征（ROC）曲线评估非侵入性方法的性能。 Z -Test用于比较ROC曲线（AUROCS）下的区域F2-F4纤维化患者具有较高的年龄，乙型肝炎E抗原（HBEAG）积极性，HBV DNA，AST，AST，GGT，LSM，APRI，FIB-4和GPR值比F0-F1纤维化患者。 Metavir纤维化阶段与LSM值正相关（r = 0.831，p <0.0001），APRI（r = 0.338，p = 0.011），FIB-4（r = 0.375，p = 0.003）和GPR（r = 0.36，p = 0.012）。为了预测先进的纤维化，LSM的菌射具有更高的AUROC（0.956 Vs 0.755，P = 0.01），FIB-4（0.956Vs 0.786，P = 0.01），与GPR相当（0.956 Vs 0.895，P = 0.2）结论：瞬时弹性显影（TE）是一种可靠的非侵入性测试，用于诊断肝纤维化。 GPR是一个新的模型，可与APRI和FIB-4相当，但差不多。

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