DIAGNOSTIC EFFICACY OF SERUM ASIALO alpha 1-ACID GLYCOPROTEIN LEVELS FOR LIVER FIBROSIS AND CIRRHOSIS IN CHB COMPARED TO HEALTHY SUBJECTS: A PROSPECTIVE STUDY

초록

Background: Serum Asialo α1-Acid Glycoprotein (AsAGP) is a novel biomarker specific for liver fibrosis. However, there is no prospective study to investigate diagnostic performance of AsAGP for fibrosis burden compared with healthy control. The aim of this study to evaluate the diagnostic efficacy of serum AsAGP level in differentiating chronic hepatitis and cirrhosis. Methods: A total of 206 subjects (68 healthy controls, 70 chronic hepatitis B, 68 hepatitis B related liver cirrhosis) were prospectively enrolled. Liver cirrhosis was classified based on liver stiffness levels (>11 kilopascal) measured by transient elastography (FibroScan). Only the cases that satisfies all the following criteria were enrolled as healthy control; absence of fatty liver in sonography, HTN, DM We compared serum AsAGP level between the three groups and evaluated diagnostic performance differentiating chronic hepatitis and cirrhosis. Results: Serum AsAGP level was significantly different between heathy control, chronic hepatitis and liver cirrhosis (1.04 ± 0.31 µg/ml, 1.12 ± 0.34 µg/ml, 1.51 ± 0.43 µg/ml respectively; p<0.001). Serum AsAGP level was positively correlated with liver stiffness (r= 0.46, p-value<0.001). We performed area under the receiver operating characteristics (AUROC) for evaluating diagnostic efficacy of AsAGP between three group. AUROC of Healthy control versus cirrhosis was 0.821 (P < 0.001). The optimal cut-off level was 1.036 µg/ml (sensitivity 88.24 %, specificity 67.6 %) AUROC of Healthy control versus chronic hepatitis was 0.624 (P < 0.001). The optimal cut-off level was 0.933 µg/ml (sensitivity 75.7%, specificity 55.9%) AUROC of chronic hepatitis versus cirrhosis was 0.765, P < 0.001). The optimal cut-off level was 1.183 µg/ml (sensitivity 73.5%, specificity 74.3%) In multivariate analysis, serum AsAGP level was the independent predictor of cirrhosis (odds ratio 129.36, p-value <0.0007) Conclusion: Serum AsAGP level in patients with cirrhosis was significantly higher than healthy controls and chronic hepatitis. AsAGP level showed a good diagnostic performance in predicting liver cirrhosis and chronic hepatitis which suggests a potential role as a biomarker for liver fibrosis.