Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C.
Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C.
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DOI：
10.1186/1476-5926-3-8
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发表时间：
2004-09-23
期刊：
影响因子：
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通讯作者：
Hainque B
中科院分区：
文献类型：
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作者：
Poynard T;Imbert-Bismut F;Munteanu M;Messous D;Myers RP;Thabut D;Ratziu V;Mercadier A;Benhamou Y;Hainque B
最近的研究强烈建议，由于活检的局限性和风险，以及生化标志物诊断准确性的提高，肝活检不应再被认为是慢性丙型肝炎患者的强制性检查。2001年，FibroTest ActiTest（FT-AT），一组生化标志物，被发现对纤维化（FT范围0.00-1.00）和坏死性炎症组织学活性（AT范围0.00-1.00）具有很高的诊断价值。其目的是总结科学文献中这些检测的诊断价值;通过进行原始的新分析来回答常见问题（包括诊断价值的范围，与其他标志物的比较，基因型和病毒载量的影响，以及中等损伤水平的诊断价值）;并开发一个肝损伤生化和活检评估之间的转换系统。共识别出16篇出版物。利用1 570项个人数据建立了一个综合数据库，并对这些数据采用了分析性建议。对照组由300名前瞻性研究的献血者组成。对于通过METAVIR评分系统诊断的显著纤维化，受试者工作特征曲线下面积（AUROC）范围为0.73 - 0.87。对于显著组织学活性的诊断，AUROC范围为0.75至0.86。在0.31的临界值时，排除显著纤维化的FT阴性预测值（患病率0.31）为91%。在临界值为0.36时，排除显著坏死的ActiTest阴性预测值（患病率0.41）为85%。在三项研究中，对相同患者的FT与其他生化标志物（包括透明质酸、Forns指数和APRI指数）进行了直接比较。所有比较均有利于FT（P < 0.05）。根据基因型或病毒载量，FT-AT的AUROC之间没有差异。对于中度和极重度阶段和等级，连续纤维化阶段和坏死等级的FT-AT AUROC相同。在连续FT-AT值（0.00至1.00）与预期的半定量纤维化分期（F0至F4）和坏死分级（A0至A3）之间构建转换表。基于这些结果，可以推荐使用肝纤维化（FibroTest）和坏死（ActiTest）的生化标志物作为肝活检的替代方法，用于评估慢性丙型肝炎患者的肝损伤。在临床实践中，肝活检应仅推荐作为二线检查，即，在生化测试错误风险高的情况下。
Recent studies strongly suggest that due to the limitations and risks of biopsy, as well as the improvement of the diagnostic accuracy of biochemical markers, liver biopsy should no longer be considered mandatory in patients with chronic hepatitis C. In 2001, FibroTest ActiTest (FT-AT), a panel of biochemical markers, was found to have high diagnostic value for fibrosis (FT range 0.00–1.00) and necroinflammatory histological activity (AT range 0.00–1.00). The aim was to summarize the diagnostic value of these tests from the scientific literature; to respond to frequently asked questions by performing original new analyses (including the range of diagnostic values, a comparison with other markers, the impact of genotype and viral load, and the diagnostic value in intermediate levels of injury); and to develop a system of conversion between the biochemical and biopsy estimates of liver injury. A total of 16 publications were identified. An integrated database was constructed using 1,570 individual data, to which applied analytical recommendations. The control group consisted of 300 prospectively studied blood donors. For the diagnosis of significant fibrosis by the METAVIR scoring system, the areas under the receiver operating characteristics curves (AUROC) ranged from 0.73 to 0.87. For the diagnosis of significant histological activity, the AUROCs ranged from 0.75 to 0.86. At a cut off of 0.31, the FT negative predictive value for excluding significant fibrosis (prevalence 0.31) was 91%. At a cut off of 0.36, the ActiTest negative predictive value for excluding significant necrosis (prevalence 0.41) was 85%. In three studies there was a direct comparison in the same patients of FT versus other biochemical markers, including hyaluronic acid, the Forns index, and the APRI index. All the comparisons favored FT (P < 0.05). There were no differences between the AUROCs of FT-AT according to genotype or viral load. The AUROCs of FT-AT for consecutive stages of fibrosis and grades of necrosis were the same for both moderate and extreme stages and grades. A conversion table was constructed between the continuous FT-AT values (0.00 to 1.00) and the expected semi-quantitative fibrosis stages (F0 to F4) and necrosis grades (A0 to A3). Based on these results, the use of the biochemical markers of liver fibrosis (FibroTest) and necrosis (ActiTest) can be recommended as an alternative to liver biopsy for the assessment of liver injury in patients with chronic hepatitis C. In clinical practice, liver biopsy should be recommended only as a second line test, i.e., in case of high risk of error of biochemical tests.