Performance Parameters of the Diagnostic Scoring Systems for Autoimmune Hepatitis
Performance Parameters of the Diagnostic Scoring Systems for Autoimmune Hepatitis
复制标题
DOI：
10.1002/hep.22513
复制
发表时间：
2008-11-01
期刊：
影响因子：
13.5
通讯作者：
Czaja, Albert J.
中科院分区：
文献类型：
--
作者：
Czaja, Albert J.
自身免疫性肝炎(AIH)的诊断标准已经由一个国际小组编纂，并公布了基于12个临床成分的原始评分系统的修订版。最近提出了一种基于四个临床组成部分的简化评分系统。这项研究的目的是比较修订的原始评分系统和简化的评分系统的性能参数，并确定每种评分系统作为诊断工具的能力。使用每种评分系统对435例各种慢性肝病患者进行诊断评分，包括153例符合临床标准的AIH患者。测定各评分系统对AIH治疗前诊断的敏感性、特异性和预测性。修订的原始评分系统诊断AIH的敏感性高于简化评分系统(100%比95%)，7例使用修订的原始评分系统诊断为AIH的患者经简化评分系统诊断为AIH(5%)。修订的原始评分系统还将21名隐源性慢性肝炎患者中的20名诊断为AIH，而简化系统仅对5名患者进行了类似的分类(95%对24%)。与修订的原始系统相比，简化系统对AM具有更高的特异性(90%比73%)和可预测性(92%比82%)，并且更常见地排除了具有同时免疫特征的其他疾病的诊断(83%比%)。结论：修订后的评分系统对AIH特征较少或不典型的患者有较好的诊断效果，对合并免疫表现的疾病的诊断有较好的排除作用。每个系统都有可以利用的属性。(《肝病》2008；48：1540-1548。)
The diagnostic criteria for auto,immune hepatitis (AIH) have been codified by an international panel, and a revision of the original scoring system based on 12 clinical components has been promulgated. A simplified scoring system has been proposed recently that is based on four clinical components. The goals of this study were to compare the performance parameters of the revised original and the simplified scoring systems and to determine the prowess of each as a diagnostic instrument. Diagnostic scores were determined using each scoring system in 435 patients with diverse chronic liver diseases, including 153 individuals with AIH by codified clinical criteria. The sensitivity, specificity, and predictability of each scoring system for the pretreatment diagnosis of AIH were determined. The revised original scoring system had greater sensitivity for the diagnosis than the simplified scoring system (100% versus 95%), and seven patients diagnosed as AIH using the revised original system were nondiagnostic by the simplified system (5%). The revised original scoring system also ascribed a diagnosis of AIH to 20 of 21 patients with cryptogenic chronic hepatitis, whereas only five patients were similarly classified by the simplified system (95% versus 24%). The simplified system had greater specificity (90% versus 73%) and predictability (92% versus 82%) for AM than the revised original system, and it more commonly excluded the diagnosis in other diseases with concurrent immune features (83% versus 64%). Conclusion: The revised original scoring system performs better in patients with few or atypical features of AIH, and the simplified system is better at excluding the diagnosis in diseases with concurrent immune manifestations. Each system has attributes that can be exploited. (HEPATOLOGY 2008;48:1540-1548.)