Predictive Ability of Laboratory Indices for Liver Fibrosis in Patients with Chronic Hepatitis C after the Eradication of Hepatitis C Virus

Liver fibrosis remains an important risk factor for hepatocarcinogenesis in patients with chronic hepatitis C even after the eradication of hepatitis C virus (HCV). However, it is difficult to estimate liver fibrosis based on liver biopsy after the eradication of HCV. We investigated the ability of laboratory indices to predict liver fibrosis in patients with sustained virologic response (SVR) to antiviral therapy. Three laboratory liver fibrosis indices (aspartate aminotransferase-platelet ratio index (APRI), FIB-4 index, and Forns index) were calculated based on data at the time of initial pretreatment liver biopsy and at second liver biopsy performed approximately 5 years after SVR in 115 patients who underwent serial liver biopsies. The indices at the time of initial biopsy were compared to histological degree of liver fibrosis in initial biopsy, and laboratory indices at the time of second liver biopsy were compared to the degree of fibrosis in second biopsy. In both comparisons, there were significant increases in all 3 indices with the increase of liver fibrosis grade as assessed in liver biopsy specimens. All 3 indices at the time of second biopsy were able to predict moderate to advanced (METAVIR score F2-4) and advanced (F3-4) fibrosis on liver biopsy, with the area under the receiver-operating characteristics curve >0.8 and the accuracy >70%. All 3 laboratory indices of fibrosis accurately reflected liver fibrosis in patients with SVR for 5 years despite the normalization of serum liver transaminase activity and the lack of liver inflammation.

慢性乙型肝炎病毒（HCV）的根除后，肝纤维化依然构成慢性乙型肝炎患者发生肝细胞癌的重要风险因素。然而，基于HCV根除后的肝活检数据来评估肝纤维化仍然存在困难。本研究旨在探讨实验室指标在预测抗病毒治疗持续病毒学反应（SVR）患者肝纤维化能力。基于初始治疗前肝活检和SVR后约5年进行的第二次肝活检数据，计算了三种实验室肝纤维化指标（天冬氨酸氨基转移酶-血小板比值指数（APRI）、FIB-4指数和Forns指数）。将初始活检时的指标与初始活检的肝纤维化组织学程度进行比较，并将第二次活检时的实验室指标与第二次活检的纤维化程度进行比较。在这两次比较中，随着肝活检标本中肝纤维化级别的升高，所有三个指标均有显著增加。第二次活检时的所有三个指标均能够预测活检中的中至重度（METAVIR评分F2-4）和重度（F3-4）纤维化，其接受者操作特征曲线下面积大于0.8，准确率大于70%。尽管血清肝转氨酶活性正常化且缺乏肝炎症，但所有三个肝纤维化实验室指标在SVR持续5年的患者中仍能准确反映肝纤维化。