What is the best strategy for investigating abnormal liver function tests in primary care? Implications from a prospective study.
What is the best strategy for investigating abnormal liver function tests in primary care? Implications from a prospective study.
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DOI：
10.1136/bmjopen-2013-003099
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发表时间：
2013-06-20
期刊：
影响因子：
2.9
通讯作者：
Girling AJ
中科院分区：
文献类型：
--
作者：
Lilford RJ;Bentham LM;Armstrong MJ;Neuberger J;Girling AJ
评价肝功能检查(LFT)在初级保健中检测肝病的预测价值。一项前瞻性的观察研究。11英国初级保健实践。患者(n=1290)，有8组LFT异常(但以前没有诊断出肝病)。患者通过记录临床特征、重复LFT、个别肝病的特异性测试和腹部超声扫描来进行调查。患者的特征是：肝细胞疾病、胆道疾病、肝胆系统肿瘤，但以上均不存在。LFT结果与疾病类别之间的关系通过逐步回归和Logistic判别进行评估，并调整人口统计学和临床因素。对所有可能的LFT组合产生的真阳性和假阳性进行了比较，以期在常规LFT面板中优化分析物的选择。回归分析显示，丙氨酸氨基转移酶(ALT)与肝细胞疾病(32例)有关，碱性磷酸酶(ALP)与胆道疾病(12例)和肝胆系统肿瘤(9例)有关。ALT和ALP的限制性小组是分析物的有效选择，与由8个分析物组成的完整小组相比是有利的，前提是可以容忍48个假阳性以获得额外的一个真阳性。重复一个完整的面板以响应异常读数不是最佳策略。当检测的目的是排除初级保健中的肝病时，LFT小组可以限制为ALT和ALP。
Evaluation of predictive value of liver function tests (LFTs) for the detection of liver-related disease in primary care. A prospective observational study. 11 UK primary care practices. Patients (n=1290) with an abnormal eight-panel LFT (but no previously diagnosed liver disease). Patients were investigated by recording clinical features, and repeating LFTs, specific tests for individual liver diseases, and abdominal ultrasound scan. Patients were characterised as having: hepatocellular disease; biliary disease; tumours of the hepato-biliary system and none of the above. The relationship between LFT results and disease categories was evaluated by stepwise regression and logistic discrimination, with adjustment for demographic and clinical factors. True and False Positives generated by all possible LFT combinations were compared with a view towards optimising the choice of analytes in the routine LFT panel. Regression methods showed that alanine aminotransferase (ALT) was associated with hepatocellular disease (32 patients), while alkaline phosphatase (ALP) was associated with biliary disease (12 patients) and tumours of the hepatobiliary system (9 patients). A restricted panel of ALT and ALP was an efficient choice of analytes, comparing favourably with the complete panel of eight analytes, provided that 48 False Positives can be tolerated to obtain one additional True Positive. Repeating a complete panel in response to an abnormal reading is not the optimal strategy. The LFT panel can be restricted to ALT and ALP when the purpose of testing is to exclude liver disease in primary care.
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影响因子：
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