Comparison and validation of simple noninvasive tests for prediction of fibrosis in chronic hepatitis C
Comparison and validation of simple noninvasive tests for prediction of fibrosis in chronic hepatitis C
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DOI：
10.1002/hep.20717
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发表时间：
2005-06-01
期刊：
影响因子：
13.5
通讯作者：
Stauber, RE
中科院分区：
文献类型：
--
作者：
Lackner, C;Struber, G;Stauber, RE
建议在抗病毒治疗前进行肝活检，特别是对丙型肝炎病毒（HCV）基因型感染的患者，但肝活检可能导致并发症，并受到抽样误差的限制。一些包括常规实验室参数（简单纤维化试验）的非侵入性试验已被提议用于预测慢性HCV的纤维化。本研究的目的是验证和比较简单纤维化试验、天冬氨酸转氨酶(AST)/丙氨酸转氨酶（ALT）比值（AAR）、肝硬化判别评分（CDS）、年龄-血小板（AP）指数、Pohl评分、AST-血小板比值指数（APRI）和血小板计数本身的诊断准确性。根据Ishak等人的研究，由两名独立的病理学家对194例未接受治疗的慢性HCV患者的肝活检标本进行分期。受试者工作特征曲线分析显示，CDS、AP指数、APRI和血小板计数在预测显著纤维化（F3-F6） （ROC曲线下面积[AUROC]，分别为0.71、0.74、0.80和0.71，病理学家A）和预测肝硬化（F5-F6） （AUROC，分别为0.91、0.91、0.90和0.89，病理学家A）的诊断准确性相当。APRI预测显著纤维化的诊断准确性优于AAR（分别在85%和78%的患者中P = 150 X 10(9)/L）。总之，仅在少数慢性丙型肝炎患者中，简单的纤维化试验可能使肝活检变得不必要。需要改进血清纤维化标志物，对严重纤维化或肝硬化有更大的敏感性。
Liver biopsy is recommended before antiviral treatment, particularly for patients with hepatitis C virus (HCV) genotype I infection, but it may cause complications and is limited by sampling error. Several non-invasive tests comprising routine laboratory parameters (simple fibrosis tests) have been proposed to predict fibrosis in chronic HCV. The aim of the current study was to validate and compare the diagnostic accuracies of the simple fibrosis tests, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), cirrhosis discriminant score (CDS), age-platelet (AP) index, Pohl score, AST-to-platelet ratio index (APRI), and platelet count per se. Staging was performed in liver biopsy specimens of 194 treatment-naive patients with chronic HCV according to Ishak et al. by two independent pathologists. Receiver operating characteristic curve analysis showed comparable diagnostic accuracies of CDS, AP index, APRI, and platelet count for prediction of significant fibrosis (F3-F6) (area under the ROC curve [AUROC], 0.71, 0.74, 0.80, and 0.71, respectively; pathologist A) and for prediction of cirrhosis (F5-F6) (AUROC, 0.91, 0.91, 0.90, and 0.89, respectively; pathologist A). Diagnostic accuracy of APRI for prediction of significant fibrosis was superior to that of AAR (P = 150 X 10(9)/L in 85% and 78% of the patients, respectively. In conclusion, simple fibrosis tests may render liver biopsy unnecessary only in a minority of patients with chronic HCV. Improved serum fibrosis markers with greater sensitivity for severe fibrosis or cirrhosis are needed.