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1. World J Hepatol. 2012 Jan 27;4(1):11-7.

Elevation of the glycated albumin to glycated hemoglobin ratio during the
progression of hepatitis C virus related liver fibrosis.

Aizawa N, Enomoto H, Imanishi H, Saito M, Iwata Y, Tanaka H, Ikeda N, Sakai Y,
Takashima T, Iwai T, Moriwaki E, Shimomura S, Iijima H, Nakamura H, Nishiguchi S.

Nobuhiro Aizawa, Hirayuki Enomoto, Hiroyasu Imanishi, Masaki Saito, Yoshinori
Iwata, Hironori Tanaka, Naoto Ikeda, Yoshiyuki Sakai, Tomoyuki Takashima, Takashi
Iwai, Ei-ichiro Moriwaki, Soji Shimomura, Hiroko Iijima, Hideji Nakamura, Shuhei
Nishiguchi, Division of Hepatobiliary and Pancreatic Disease, Department of
Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya,
Hyogo 663-8501, Japan.

AIM: To analyze the relationship between the glycated albumin (GA) to glycated
hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.
METHODS: The study retrospectively included consecutive hepatitis C virus
positive chronic liver disease patients (n = 142) who had undergone percutaneous
liver biopsy between January 2008 and March 2010 at our institution. The ratios
of GA/HbA1c were calculated in all patients to investigate the relationship with
the degree of the liver fibrosis. The values of the aspartate
aminotransferase-to-platelet ratio index (APRI), an excellent marker for the
evaluation of liver fibrosis, were also calculated. In addition, we combined the
ratio of GA/HbA1c and the APRI in order to improve our ability to detect the
presence of significant liver fibrosis.
RESULTS: Sixty-one (43%) patients had either no fibrosis or minimal fibrosis
(METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six
(39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The
mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1:
2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a
significant difference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P
< 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was
significantly higher in the patients with cirrhosis (F4) than in those without
cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio
was also significantly higher in the patients with severe fibrosis (F3-F4) than
in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P <
0.001). Furthermore, the GA/HbA1c ratio was also significantly higher in the
patients with significant fibrosis (F2-F4) than in those without significant
liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic
performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its
sensitivity and specificity for the detection of liver cirrhosis (F4) were 59.3%
and 70.4%, respectively and its sensitivity and specificity for the detection of
severe liver fibrosis (F3-F4) were 50.0% and 74.4%, respectively. With regard to
the detection of significant fibrosis (F2-F4), its sensitivity was 44.4% and its
specificity was 77.0%. Although even the excellent marker APRI shows low
sensitivity (25.9%) for distinguishing patients with or without significant
fibrosis, the combination of the APRI and GA/HbA1c ratio increased the
sensitivity up to 42.0%, with only a modest decrease in the specificity (from
90.2% to 83.6%).
CONCLUSION: The GA/HbA1c ratio increased in line with the histological severity
of liver fibrosis, thus suggesting that this ratio is useful as a supportive
index of liver fibrosis.

PMCID: PMC3272076
PMID: 22312451 [PubMed - in process]