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World J Gastroenterol. Dec 7, 2005; 11(45): 7192-7196
Published online Dec 7, 2005. doi: 10.3748/wjg.v11.i45.7192
Diagnostic accuracy of serum biochemical fibrosis markers in children with chronic hepatitis B evaluated by receiver operating characteristics analysis
Dariusz Marek Lebensztejn, Elżbieta Skiba, Jolanta Tobolczyk, Maria Elżbieta Sobaniec-Lotowska, Maciej Kaczmarski
Dariusz Marek Lebensztejn, Elżbieta Skiba, Maciej Kaczmarski, IIIrd Department of Pediatrics, Medical University of Bialystok, Poland
Jolanta Tobolczyk, Department of Children Allergology, Medical University of Bialystok, Poland
Maria Elżbieta Sobaniec-Lotowska, Department of Clinical Pathomorphology, Medical University of Bialystok, Poland
Author contributions: All authors contributed equally to the work.
Correspondence to: Assistant Professor Dariusz Marek Lebensztejn, MD, IIIrd Department of Pediatrics, Medical University of Bialystok, 17 Waszyngtona Str., 15-274 Bialystok, Poland. dariuszmar. 8810735@pharmanet.com.pl
Telephone: +48-85-7450539 Fax: +48-85-7423841
Received: April 12, 2005
Revised: April 23, 2005
Accepted: April 30, 2005
Published online: December 7, 2005
Abstract

AIM: To investigate the diagnostic accuracy of potent serum biochemical fibrosis markers in children with chronic hepatitis B evaluated by receiver operating characteristics (ROC) analysis.

METHODS: We determined the serum level of apolipoprotein A-I (APO A-I), haptoglobin (HPT) and a-2 macroglobulin (A2M) with an automatic nephelometer in 63 children (age range 4-17 years, mean 10 years) with biopsy-verified chronic HBeAg-positive hepatitis B. Fibrosis stage and inflammation grade were assessed in a blinded fashion according to Batts and Ludwig. We defined mild liver fibrosis as a score ≤2 and advanced fibrosis as a score equal to 3. ROC analysis was used to calculate the power of the assays to detect advanced liver fibrosis (AccuROC, Canada).

RESULTS: Serum concentrations of APO A-I, HPT and A2M were not significantly different in patients with chronic hepatitis B compared to controls. However, APO A-I level of 1.19 ng/L had a sensitivity of 85.7% and a specificity of 60.7% (AUC = 0.7117, P = 0.035) to predict advanced fibrosis. All other serum biochemical markers and their combination did not allow a useful prediction. None of these markers was a good predictor of histologic inflammation.

CONCLUSION: Apolipoprotein A-I may be a suitable serum marker to predict advanced liver fibrosis in children with chronic hepatitis B.

Keywords: Chronic hepatitis B; Liver fibrosis; Children; Apolipoprotein A-I; Haptoglobin; a-2 macroglobulin