Serum biochemical markers accurately predict liver fibrosis in HIV and hepatitis C virus co-infected patients
Serum biochemical markers accurately predict liver fibrosis in HIV and hepatitis C virus co-infected patients
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DOI：
10.1097/00002030-200303280-00010
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发表时间：
2003-03-28
期刊：
影响因子：
3.8
通讯作者：
Poynard, T
中科院分区：
文献类型：
--
作者：
Myers, RP;Benhamou, Y;Poynard, T
目的：肝活检是评估丙型肝炎病毒(HCV)相关纤维化的金标准，具有侵入性且易发生并发症。设计：在一家法国三级保健医院的横断面队列研究中，130名HIV/丙型肝炎合并感染患者进行了肝活检和血清肝纤维化标志物检测。方法：采用多元Logistic回归方法，将年龄、性别、α(2)-巨球蛋白、载脂蛋白A1、结合珠蛋白、胆红素和γ-谷氨酰转肽酶(GGT)的指标与肝脏组织学进行比较。还构建了HIV特异性指标，包括CD4细胞计数和HIV-RNA载量。用受试者工作特征(ROC)曲线比较各指标的诊断价值。主要观察指标：间隔纤维化(F2-F4)按METAVIR分类。结果：经多因素分析，最具信息量的标志物是α(2)-巨球蛋白、载脂蛋白A1、GGT和性别。五项指标的ROC曲线下面积为0.856+/-0.035，与HIV特异性指标无显著差异。在从0到1.00的范围内，五分指数对得分大于0.60的患者的阳性预测值为86%，对得分小于或等于0.20的患者的阴性预测值为93%。这些阈值可以将肝活检的必要性降低55%，同时保持89%的准确率。结论：包括5个生化标志物的指标可以准确地预测艾滋病毒/丙型肝炎合并感染患者的显著纤维化，并可能显著降低肝活检的必要性。(C)2003年，里平科特·威廉姆斯·威尔金斯。
Objective: Liver biopsy, the gold standard for assessing hepatitis C virus (HCV)-related fibrosis, is invasive and prone to complications. Our aim was to determine the operating characteristics of a non-invasive index of biochemical markers for the prediction of fibrosis in patients with HIV/HCV co-infection.Design: In a cross-sectional, cohort study in a French tertiary-care hospital 130 HIV/HCV-co-infected patients with a liver biopsy and serum were tested for markers of liver fibrosis.Methods: An index incorporating age, sex, alpha(2)-macroglobulin, apolipoprotein A1, haptoglobin, bilirubin, and gamma-glutamyl-transpeptidase (GGT), derived using multivariate logistic regression, was compared with liver histology. HIV-specific indices including the CD4 cell count and HIV-RNA load were also constructed. The diagnostic values of the indices were compared using receiver operating characteristic (ROC) curves.Main outcome measure: Septal fibrosis (F2-F4) by the METAVIR classification.Results: By multivariate analysis, the most informative markers were alpha(2)-macroglobulin, apolipoprotein A1, GGT, and sex. The area under the ROC curve of the five-marker index was 0.856+/-0.035; not significantly different from the HIV-specific indices. On a scale from zero to 1.00, the five-marker index had a positive predictive value of 86% for scores greater than 0.60, and a negative predictive value of 93% for scores of 0.20 or less. These thresholds could reduce the necessity for liver biopsy by 55% while maintaining an accuracy of 89%.Conclusion: An index including five biochemical markers accurately predicts significant fibrosis in patients with HIV/HCV co-infection, and may substantially reduce the necessity for liver biopsy. (C) 2003 Lippincott Williams Wilkins.