Abstract：
Assessment of liver fibrosis by non-invasive means is clinically important. Studies in chronic hepatitis delta (CHD) are scarce. We evaluated the performance of eight serum fibrosis markers [fibrosis-4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), age-platelet index (API), AST-to platelet-ratio-index (APRI), Goteborg University Cirrhosis Index (GUCI), Lok index, cirrhosis discriminant score (CDS) and Hui score] in CHD and chronic hepatitis B (CHB). Liver stiffness was assessed by transient elastography (TE) in CHD. The ability of fibrosis markers to detect significant fibrosis and cirrhosis were evaluated in 202 CHB and 108 CHD patients using published and new cut-offs through receiver operating characteristics (ROC) analysis. The latter was also applied to obtain cut-offs for TE. APRI, Fib-4, API and Hui score were assessed for significant fibrosis, and APRI, GUCI, Lok index, CDS and AAR for cirrhosis determination. Fibrosis markers displayed weak performance in CHB for significant fibrosis with area under ROC (AUROC) curves between 0.62 and 0.71. They did slightly better for CHD. TE displayed an AUROC of 0.92 and performed better than serum fibrosis markers (p < 0.05 for fibrosis markers). For cirrhosis determination, CDS and Lok Index displayed an AUROC of 088 and 0.89 in CHB and GUCI, Lok index and APRI displayed AUROCs around 0.90 in CHD. TE displayed the best AUROC (0.95). Hence TE is superior to serum fibrosis markers for diagnosing significant liver fibrosis and cirrhosis. GUCI, Lok index and APRI displayed a reasonable performance in CHD, which needs further confirmation.
摘要：
通过非侵入性手段评估肝纤维化是临床上重要的研究慢性丁型肝炎（CHD）很少。评价8种血清纤维化标志物[纤维化-4评分(FIB-4),天冬氨酸转氨酶（AST）与丙氨酸转氨酶（ALT）的比值（AAR），年龄-血小板指数(API),AST与血小板比率指数（APRI），哥德堡大学肝硬化指数（GUCI），Lok指数,CHD和慢性乙型肝炎（CHB）的肝硬化判别评分（CDS）和Hui评分]。通过瞬时弹性成像（TE）评估CHD的肝脏硬度。纤维化标志物检测显著纤维化和肝硬化的能力在202CHB和108CHD患者使用发表和新的截止通过接收器操作特征（ROC）分析进行评估。后者也用于获得TE的截止值。APRI,Fib-4，API和Hui评分被评估为显著的纤维化，和APRI,GUCI,Lok指数,CDS和AAR用于肝硬化测定。纤维化标志物在CHB中表现出明显纤维化的弱性能，ROC（AUROC）曲线下的面积在0.62至0.71之间。他们对CHD做得稍微好一点。TE显示0.92的AUROC并且表现优于血清纤维化标志物(对于纤维化标志物,p<0.05)。对于肝硬化的测定，CDS和Lok指数在CHB和GUCI中显示AUROC为088和0.89,Lok指数和APRI在CHD中显示AUROC约为0.90。TE显示最佳AUROC(0.95)。TE在诊断显著肝纤维化和肝硬化方面优于血清纤维化标志物。GUCI，Lok指数和APRI在CHD中显示出合理的表现，需要确认。
