Comparison of simple tests for the non-invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C
Comparison of simple tests for the non-invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C
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DOI：
10.1111/j.1365-2036.2006.03034.x
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发表时间：
2006-09-01
影响因子：
7.6
通讯作者：
Salerno, F.
中科院分区：
文献类型：
--
作者：
Borroni, G.;Ceriani, R.;Salerno, F.
活组织检查是评估慢性丙型肝炎病毒感染患者肝硬化的金标准，但它昂贵且有并发症风险。替代的非侵入性方法已经开发出来，但其实用性仍不确定。比较五种无创评分对肝硬化诊断的准确性。我们回顾了228例连续未接受治疗的丙型肝炎病毒阳性患者的图表和肝活检，其中13.2%的患者组织学诊断为肝硬化。5个备选评分分别为年龄血小板指数、肝硬化判别评分、天冬氨酸转氨酶与血小板比值指数、Pohl指数和天冬氨酸转氨酶/丙氨酸转氨酶比值。特异性较好（87-100%），敏感性较差（17-67%）。因此，正似然比通常是好的，而负似然比则是次优的。与肝硬化独立相关的评分组合仅略微改变了诊断的准确性。采用双截止值排除/诊断肝硬化，肝硬化判别评分无误诊率为21%，天门冬氨酸转氨酶与血小板比值指数误诊率为85%，误诊率为9%。这五种评分在单独和联合检测肝硬化方面表现出不同的敏感性和特异性。双分界点的使用可以使肝硬化判别评分和天冬氨酸转氨酶与血小板比值指数有助于减少肝活检患者的数量。
Biopsy is the gold standard for assessing cirrhosis in patients with chronic hepatitis C virus infection, but it is expensive and at risk of complications. Alternative non-invasive methods have been developed but their usefulness remains uncertain.To compare the accuracy of five non-invasive scores in detecting cirrhosis.We reviewed the charts and liver biopsies of 228 consecutive, treatment-naive, hepatitis C virus-positive patients, 13.2% of whom with histological diagnosis of cirrhosis. The five alternative scores were age-platelet index, cirrhosis discriminant score, aspartate transaminases to platelet ratio index, Pohl's index, and aspartate transaminases/alanine transaminases ratio.The specificities of the scores were good (87-100%), but not so their sensitivities (17-67%). Accordingly positive likelihood ratios were generally good but negative likelihood ratios were suboptimal. Combinations of the scores independently related to cirrhosis only slightly change this diagnostic accuracy. Using double cut-offs to exclude/diagnoses cirrhosis, cirrhosis discriminant score classified 21% of patients without misdiagnoses and aspartate transaminases to platelet ratio index classified 85% of case with 9% of misdiagnoses.The five scores showed variable sensitivities and specificities in detecting liver cirrhosis, both individually and in combination. The use of double cut-off points may make the cirrhosis discriminant score and aspartate transaminases to platelet ratio index useful to reduce the number of patients submitted to liver biopsy.