Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: The ANRS HCEP-23 study

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• 作者：Jean-Pierre Zarski¹ ;   ; ² ;   ; ^{JPZarski@chu-grenoble.fr} ; Nathalie Sturm² ;   ; ³ ; Jé ; rô ; me Guechot⁴ ; Adeline Paris⁵ ; Elie-Serge Zafrani⁶ ; Tarik Asselah⁷ ; René ; e-Claude Boisson⁸ ; Jean-Luc Bosson⁵ ; Dominique Guyader⁹ ; Jean-Charles Renversez¹⁰ ; Jean-Pierre Bronowicki¹¹ ; Marie-Christine Gelineau¹² ; Albert Tran¹³ ; Candice Trocme¹⁴ ; Victor De Ledinghen¹⁵ ; Elisabeth Lasnier⁴ ; Armelle Poujol-Robert¹⁶ ; Fré ; dé ; ric Ziegler¹⁷ ; Marc Bourliere¹⁸ ; Hé ; lè ; ne Voitot¹⁹ ; Dominique Larrey²⁰ ; Maria Alessandra Rosenthal-Allieri²¹ ; Isabelle Fouchard Hubert²² ; Franç ; ois Bailly²³ ; Michel Vaubourdolle⁴ ; The ANRS HCEP 23 Fibrostar Group
• 关键词：Chronic hepatitis C ; Liver fibrosis ; Surrogate markers ; Transient elastography ; Blood tests
• 刊名：Journal of Hepatology
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：56
• 期：1
• 页码：55-62
• 全文大小：691 K

文摘

Background & Aims

Blood tests and transient elastography (Fibroscan? have been developed as alternatives to liver biopsy. This ANRS HCEP-23 study compared the diagnostic accuracy of nine blood tests and transient elastography (Fibroscan? to assess liver fibrosis, vs. liver biopsy, in untreated patients with chronic hepatitis C (CHC).

Methods

This was a multicentre prospective independent study in 19 French University hospitals of consecutive adult patients having simultaneous liver biopsy, biochemical blood tests (performed in a centralized laboratory) and Fibroscan? Two experienced pathologists independently reviewed the liver biopsies (mean length = 25 ¡À 8.4 mm). Performance was assessed using ROC curves corrected by Obuchowski¡¯s method.

Results

Fibroscan?was not interpretable in 113 (22 % ) patients. In the 382 patients having both blood tests and interpretable Fibroscan? Fibroscan?performed similarly to the best blood tests for the diagnosis of significant fibrosis and cirrhosis. Obuchowski¡¯s measure showed Fibrometer? (0.86), Fibrotest? (0.84), Hepascore? (0.84), and interpretable Fibroscan?(0.84) to be the most accurate tests. The combination of Fibrotest?, Fibrometer?, or Hepascore? with Fibroscan?or Apri increases the percentage of well classified patients from 70?3 % to 80?3 % for significant fibrosis, but for cirrhosis a combination offers no improvement. For the 436 patients having all the blood tests, AUROC¡¯s ranged from 0.82 (Fibrometer?) to 0.75 (Hyaluronate) for significant fibrosis, and from 0.89 (Fibrometer? and Hepascore?) to 0.83 (FIB-4) for cirrhosis.

Conclusions

Contrarily to blood tests, performance of Fibroscan?was reduced due to uninterpretable results. Fibrotest?, interpretable Fibroscan? Fibrometer?, and Hepascore? perform best and similarly for diagnosis of significant fibrosis and cirrhosis.