Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study
Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study
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DOI：
10.1016/s0140-6736(00)04258-6
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发表时间：
2001-04-07
期刊：
影响因子：
168.9
通讯作者：
Poynard, T
中科院分区：
文献类型：
--
作者：
Imbert-Bismut, F;Ratziu, V;Poynard, T
背景肝活检被认为是丙型肝炎病毒（HCV）感染患者管理的强制性检查，特别是对肝纤维化进行分期。我们的目的是，在我们的前瞻性研究，以评估的预测价值的组合的基本血清生化标志物诊断临床显著的纤维化（包括早期阶段）。方法我们评估肝活检患者与可检测的HCV PCR，资格，并采取了血液样本的程序的一天。第一年对205名患者进行了分析，然后在第二年对134名患者进行了测试。我们设计了一个纤维化指数，其中包括第一年组最具信息性的标志物（结合年龄和性别）。评估了11种血清标志物以及纤维化分期：F0=无纤维化，F1=门静脉纤维化;对于临床显著的纤维化，F2=少隔，F3=多隔，F4=肝硬化。Logistic回归，神经连接，和受试者工作特征（ROC）curves.Findings第一年和第二年的患者组特征和生化标志物的统计分析没有显着差异。具有临床意义的纤维化的总频率为40%（138例患者）。信息量最大的标记物是：α（2）巨球蛋白、α（2）球蛋白（或触珠蛋白）、γ球蛋白、载脂蛋白A（1）。γ谷氨酰转肽酶和总胆红素。第一年（0.836 [0.430]）和第二年组（0.870 [0.340]）的ROC曲线下面积（SD）无差异（p=0.44）。用最佳指数，阴性预测值高（100%确定不存在F2、F3或F4）的评分范围为0 - 0.10（占所有患者的12% [41]），阳性预测值高（F2、F3存在的确定性>90%，或F4），评分范围为0.60至1.00（占所有患者的34% [115]）基本血清标志物的组合可用于显著减少慢性HCV感染患者的肝活检次数。
Background Liver biopsy is thought mandatory for management of patients with hepatitis C virus (HCV) infection, especially for staging fibrosis. We aimed, in our prospective study, to assess the predictive value of a combination of basic serum biochemical markers for diagnosis of clinically significant fibrosis (Including early stages).Methods We assessed liver-biopsy patients with detectable HCV by PCR, for eligibility, and took a blood sample on the day of the procedure. The analysis was done in a first-year period for 205 patients and then tested in a second period on 134 patients. We devised a fibrosis index that included the most informative markers (combined with age and sex) for the first-year group. 11 serum markers were assessed as well as fibrosis stage: F0=no fibrosis and F1=portal fibrosis; and for clinically significant fibrosis, F2=few septa, F3=many septa, and F4=cirrhosis. Statistical analysis was by logistic regression, neural connection,and receiver-operating characteristic (ROC) curves.Findings First-year and second-year patient-group characteristics and biochemical markers did not differ. The overall frequency of clinically significant fibrosis was 40% (138 patients). The most informative markers were: alpha (2) macroglobulin, alpha (2) globulin (or haptoglobin), gamma globulin, apolipoprotein A(1). gamma glutamyltranspeptidase, and total bilirubin. The areas (SD) under the ROC curves for the first-year (0.836 [0.430]) and second-year groups (0.870 [0.340]) did not differ (p=0.44). With the best index, a high negative predictive value (100% certainty of absence of F2, F3, or F4) was obtained for scores ranging from zero to 0.10 (12% [41] of all patients), and high positive predictive value (>90% certainty of presence of F2, F3, or F4) for scores ranging from 0.60 to 1.00 (34% [115] of all patients).Interpretation A combination of basic serum markers could be used to substantially reduce the number of liver biopsies done in patients with chronic HCV infection.