本研究旨在探讨新的非侵入性标志物在预测原发性胆汁性胆管炎(PBC)个体肝纤维化中的准确性。该回顾性分析包括进行了肝活检的PBC受试者。使用Scheuer分类来确定纤维化阶段。胆红素与白蛋白(Alb)的比值(BAR),基于四个因素的纤维化指数(FIB-4),γ-谷氨酰转肽酶与血小板(PLT)的比值(GPR),红细胞分布宽度与PLT比(RPR),天冬氨酸转氨酶(AST)与丙氨酸转氨酶(AAR)的比值,根据实验室参数计算AST与PLT比值指数(APRI)和总胆红素与PLT比值(TPR)。一个名为BARP的新索引被认为是BARxRPR。共有78名PBC患者被纳入研究,84.6%的患者有明显的纤维化,30.8%有晚期纤维化,15.4%有肝硬化。在多变量分析中,Alb被确定为晚期纤维化的独立预测因子(比值比=0.823,P=0.034)。BAR的接收器工作特性曲线(AUROC)下的面积,GPR,TPR和BARP在预测严重纤维化方面具有统计学意义(P<0.05),分别为0.747、0.684、0.693和0.696。在评估晚期纤维化时,AAR的AUROC,APRI,BAR,FIB-4,RPR,TPR和BARP分别为0.726、0.650、0.742、0.716、0.670、0.735和0.750。APRI的AUROC,BAR,FIB-4,RPR,用于肝硬化预测的TPR和BARP分别为0.776、0.753、0.821、0.819、0.808和0.832。通过比较AUROC,研究表明,在预测晚期纤维化方面,BARP(P=0.021)和TPR(P=0.044)的诊断能力优于APRI.总之,BAR,BARP和TPR对PBC肝纤维化分级具有预测价值,Alb对早期纤维化具有诊断价值。上述非侵入性指标可用于预测PBC的组织学分期。
The present study aimed to investigate the accuracy of new noninvasive markers in predicting liver fibrosis among individuals with primary biliary cholangitis (PBC). This retrospective analysis included subjects with PBC who had liver biopsies. Scheuer\'s classification was used to determine the fibrosis stage. The bilirubin to albumin (Alb) ratio (BAR), fibrosis index based on the four factors (FIB-4), γ-glutamyl transpeptidase to platelet (PLT) ratio (GPR), red cell distribution width to PLT ratio (RPR), aspartate aminotransferase (AST) to alanine aminotransferase ratio (AAR), AST to PLT ratio index (APRI) and total bilirubin to PLT ratio (TPR) were calculated based on the laboratory parameters. A novel index called BARP was conceived as BAR x RPR. A total of 78 individuals with PBC were included in the study, 84.6% of whom had significant fibrosis, 30.8% had advanced fibrosis and 15.4% had cirrhosis. In the multivariate analysis, Alb was determined to be an independent predictor of advanced fibrosis (odds ratio=0.823, P=0.034). The area under the receiver operating characteristic curves (AUROCs) of the BAR, GPR, TPR and BARP were statistically significant in predicting severe fibrosis (P<0.05) and were 0.747, 0.684, 0.693 and 0.696, respectively. In assessing advanced fibrosis, the AUROCs for the AAR, APRI, BAR, FIB-4, RPR, TPR and BARP were 0.726, 0.650, 0.742, 0.716, 0.670, 0.735 and 0.750, respectively. The AUROCs for the APRI, BAR, FIB-4, RPR, TPR and BARP for cirrhosis prediction were 0.776, 0.753, 0.821, 0.819, 0.808 and 0.832, respectively. By comparing the AUROCs, it was demonstrated that the diagnostic capabilities of the BARP (P=0.021) and TPR (P=0.044) were superior to those of the APRI in predicting advanced fibrosis. In conclusion, the BAR, BARP and TPR were of predictive value for the grade of liver fibrosis in PBC and Alb had a diagnostic value in identifying early fibrosis. The aforementioned noninvasive indices may be used for predicting histologic stages of PBC.