The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
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Efficacy of AST to Platelet Ratio Index in Predicting Severe Hepatic Fibrosis and Cirrhosis in Chronic Hepatitis B Virus Infection

만성 B형 간염 환자에서 중증 간 섬유화 및 간경변의 예측 지표로써 AST/혈소판 비의 유용성

Sim, Sung-Jun;Cheong, Jae-Youn;Cho, Sung-Won;Kim, Jong-Su;Lim, Tae-Young;Shin, Do-Hyun;Lim, Sun-Gyo;Kim, Young-Bae;Lee, Kee-Myung;Yoo, Byung-Moo;Lee, Kwang-Jae;Hahm, Ki-Baik;Kim, Jin-Hong
심성준;정재연;조성원;김종수;임태영;신도현;임선교;김영배;이기명;유병무;이광재;함기백;김진홍

  • Published : 20050500
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Abstract

BACKGROUND/AIMS: An ideal noninvasive diagnostic test for hepatic fibrosis should be simple, inexpensive, and accurate. We aimed to find the simple marker for predicting hepatic fibrosis and to compare the accuracy of AST, platelet, AST/ALT ratio and AST to platelet ratio index (APRI) in chronic hepatitis B patients without clinical evidence of cirrhosis. METHODS: A total of one hundred and twenty-six chronic hepatitis B patients who underwent liver biopsy at the Ajou University Hospital from August 1998 to December 2003 were enrolled. Hepatic fibrosis was assessed using the Ludwig classification. Significant fibrosis was defined as fibrosis score of 3 or more. The AST/ALT ratio and APRI were calculated and correlations with hepatic fibrosis were analyzed. RESULTS: APRI showed a significant correlation (r=0.501, p=0.000) with hepatic fibrosis, and was superior to AST, AST/ALT ratio and platelet in predicting fibrosis. Patients with significant fibrosis (fibrosis stage 3, 4) can be identified to have APRI=1 with sensitivity 71.2% and specificity 70.3%. The sensitivity and specificity of an APRI = 1.5 for cirrhosis (stage 4) were 83.3% and 75.0%. CONCLUSIONS: Simple index using AST and platelet value can predict the presence of significant fibrosis and cirrhosis in chronic hepatitis B patients without clinical evidence of cirrhosis.

목적: 간섬유화를 예측하는 이상적인 비침습 검사는 간단하고,저렴하면서도 정확해야 한다.이번 연구는 임상소견에 뚜렷한 간경변의 증거가 없는 만성 B형 간염 환자들에서 쉽게 측정 가능한 AST, ALT, 혈소판치를 이용한 비침습간섬유화 표지자인 AST/ALT 비, AST/혈소판 비와 간생검결과를 비교하여 간섬유화 정도를 가장 정확히 반영하는 표지자를 알아보고자 하였다. 대상 및 방법: 1998년 8월부터2003년 12월까지 아주대학교병원을 내원한 만성 B형 간염환자 중 간경변의 명백한 증후 없이 간생검을 시행한 126명을 대상으로 하였다.중증 간섬유화(섬유화 3, 4단계) 및 간경변(섬유화4단계)의 정의는 Ludwig 분류에 따랐다. 결과:AST/혈소판 비는 간섬유화와 유의한 상관관계를 보였고(r=0.501, p=0.000), 중증 간섬유화 및 간경변의 예측에 AST및 혈소판치보다 우수하였다. AST/ALT 비는 간섬유화와 유의한 상관관계가 없었다(r=0.004). AST/혈소판 비의 진단 유용성을 알아보기 위해 ROC curve를 이용하여 임상적으로유용한 cut-off 값을 설정하였다. 중증 간섬유화의 예측을 위해 APRI 값이 1 이상일 때 민감도 71.2%, 특이도 70.3%, 양성 예측도 62.7%, 음성 예측도 77.6%였고, 간경변의 예측은APRI 값을 1.5 이상으로 할 때 민감도 83.3%, 특이도 75.0%,양성 예측도 35.7%, 음성 예측도 96.4%였다. 결론: 임상으로간경변의 증후가 없는 만성B형 간염 환자들에서AST/혈소판 비는 비교적 정확하게 중증 간섬유화 및 간경변을 예측하였고, 이는 임상에서 쉽게 이용할 수 있는 유용한 간섬유화 예측 표지자라고 생각한다.

Keywords

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