Non-invasive
Technique for Assessing Fibrosis in Hepatitis B Patients
Liver
biopsy is considered the "gold standard" for assessing the extent of
liver fibrosis, which helps guide decisions about whether a patient with chronic
hepatitis B should receive treatment. However, biopsies are expensive, uncomfortable,
and associated with a small risk of complications, so researchers have explored
various noninvasive methods for estimating fibrosis stage.
As
reported at the 57th annual meeting of the American Association for Liver Diseases
(AASLD) last month in Boston, researchers from Beijing Friendship Hospital in
China conducted a prospective multicenter study to assess the accuracy of non-invasive
diagnostic methods using panels of serum markers and ultrasonography to determine
the severity of liver fibrosis in patients with hepatitis B. A total of 270 consecutive
patients with chronic HBV infection and available liver biopsy results were included.
Twenty-six common
clinical and serum markers were analyzed to derive 2 diagnostic models for discriminating
stages of liver fibrosis. A subset of 110 patients underwent color Doppler ultrasound
examination, and 20 ultrasonographic variables were analyzed.
Results
•
4
markers were identified and a predictive fibrosis model was derived against the
Scheuer's scoring system by multivariate logistic regression analysis:
•
4
serum markers were identified and a fibrosis scoring index was also constructed
against the Chevallier's semi-quantitative scoring system by multiple linear stepwise
regression analysis:
- platelet count; - HA; - GGT; - albumin
level.
•
The
area under the curve (AUC) of the model was 0.889 for the estimation group and
0.850 for the validation group for discriminating stage 3 or higher fibrosis from
stage 2 or lower fibrosis.
•
Using
a cut-off score of 3.0, the model had a sensitivity of 90.2%, a specificity of
76.1%, and an accuracy of 82%.
•
There
was a positive linear relationship between the model score and fibrosis stage
(R = 0.731; P < 0.001).
•
There
was a significant positive linear correlation between the scoring index and pathologic
semi-quantitative scores (R = 0.719; P < 0.001).
•
An
ultrasonic semi-quantitative scores system including anterior liver surface, edge,
parenchyma, intrahepatic vessels, Doppler waveform of the hepatic vein, smoothness
of the gallbladder wall, and area of the spleen was constructed.
•
Total
ultrasonic scores were well correlated with the histological stage of fibrosis
(R = 0.824; P < 0.001).
•
The
AUCs of the scores system for identifying liver fibrosis stages were 0.946 for
stage 2 or higher, 0.914 for stage 3 or higher, and 0.915 for stage 4.
Conclusion
In
conclusion, the researchers wrote, "A set of laboratory and ultrasonic assessment
systems were found to be useful to reflect the degree of liver fibrosis in chronic
hepatitis B."
11/21/06
Reference W
Zhang, B Wang, J Jia, and other. Noninvasive diagnosis of the degree of hepatic
fibrosis using serum markers and ultrasonography in patients with chronic hepatitis
B. 57th AASLD. Boston, MA. October 27-31, 2006. Abstract 707.
