Liver biopsy is the gold standard for detecting the degree of liver fibrosis; however, invasiveness constitutes its main limiting factor in clinical application, so we aimed to evaluate the non-invasive biomarker formulas (APRI and FIB-4) and their modified forms by BMI z-score (M-APRI, M-FIB-4, and B-AST) compared to liver biopsy in the assessment of liver fibrosis in children with chronic liver diseases. Two hundred children aged 6.3 ± 3.8 years (98 males, 102 females) with chronic liver diseases underwent liver biopsy. The stage of fibrosis was assessed according to the METAVIR system for all children, and the following non-invasive biomarker formulas were calculated: APRI, modified APRI (M-APRI: BMI z-score × APRI), Fibrosis-4 index (FIB-4), modified FIB-4 (M-FIB-4: BMI z-score × FIB-4), and B-AST (BMI z-score × AST). The best cutoff value was calculated to detect early fibrosis (F1–F2) from advanced liver fibrosis (F3–F4). There were positive correlations between all studied non-invasive biomarker models (APRI, FIB-4, M-APRI, M-FIB-4, B-AST) and fibrosis score as an increase in fibrosis score was associated with an increase in mean ± SD of all studied biomarker formulas. The best cutoff values of non-invasive biomarker models in the diagnosis of early fibrosis (F1–F2) were APRI > 0.96, M-APRI > 0.16, FIB-4 > 0.019, M-FIB-4 > 0.005, and B-AST > −8 with an area under the curve above 0.7 each, while the best cutoff values of non-invasive biomarker models (APRI, M-APRI, FIB-4, M-FIB-4, and B-AST) in the diagnosis of advanced liver fibrosis (F3–F4) were >1.96, >2.2, >0.045, and >0.015, >92.1, respectively, with an area under the curve above 0.8 each. APRI, M-APRI, FIB-4, M-FIB-4, and B-AST are good non-invasive alternatives to liver biopsy in the detection of liver fibrosis in children with chronic liver diseases of different etiologies especially those that include BMI z-scores in their formulas.

中文翻译：

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肝活检与非侵入性生物标志物评估慢性肝病患儿肝纤维化的比较研究

肝活检是检测肝纤维化程度的金标准；然而，侵入性是其临床应用的主要限制因素，因此我们旨在通过 BMI z-score（M-APRI、M-FIB-4、和 B-AST) 与肝活检在评估慢性肝病儿童肝纤维化方面的比较。200 名 6.3 ± 3.8 岁（男 98 名，女 102 名）患有慢性肝病的儿童接受了肝活检。根据 METAVIR 系统评估所有儿童的纤维化分期，并计算以下非侵入性生物标志物公式：APRI、改良 APRI（M-APRI：BMI z-score × APRI）、Fibrosis-4 指数（FIB- 4)、修改后的 FIB-4 (M-FIB-4: BMI z-score × FIB-4) 和 B-AST (BMI z-score × AST)。计算最佳截止值以检测晚期肝纤维化（F3-F4）的早期纤维化（F1-F2）。所有研究的非侵入性生物标志物模型（APRI、FIB-4、M-APRI、M-FIB-4、B-AST）与纤维化评分之间存在正相关，因为纤维化评分的增加与平均值±所有研究的生物标志物公式的 SD。非侵入性生物标志物模型在诊断早期纤维化（F1-F2）中的最佳截断值为 APRI > 0.96、M-APRI > 0.16、FIB-4 > 0.019、M-FIB-4 > 0.005 和 B-AST > -8，曲线下面积均大于 0.7，而无创生物标志物模型（APRI、M-APRI、FIB-4、M-FIB-4 和 B-AST）在诊断晚期肝纤维化 (F3-F4) 分别 >1.96、>2.2、>0.045 和 >0.015、>92.1，曲线下面积均大于 0.8。APRI、M-APRI、FIB-4、M-FIB-4 和 B-AST 是肝活检的良好非侵入性替代方法，可用于检测不同病因的慢性肝病尤其是那些包括 BMI z 的儿童的肝纤维化- 在他们的公式中得分。