Tran A, Hastier P, Barjoan E M, Demuth N, Pradier C, Saint-Paul M C, Guzman-Granier E, Chevallier P, Tran C, Longo F, Schneider S, Piche T, Hebuterne X, Benzaken S, Rampal P
Service d'Hépato-Gastroentérologie, Hôpital de l'Archet 2, Nice.
Gastroenterol Clin Biol. 2000 Jun-Jul;24(6-7):626-30.
The aim of this study was to assess the diagnostic accuracy of noninvasive markers of liver fibrosis in alcoholic liver disease.
Fifty-four clinical and biochemical parameters including serum fibrosis markers (hyaluronate and transforming growth factor beta1) were analyzed in 146 consecutive heavy drinkers (106 men, 40 women; mean age 49.2 years). Following liver biopsy, fibrosis was evaluated using a semi-quantitative scoring system (no fibrosis (0) to severe fibrosis (3 + )). Multivariate analysis was performed to determine the markers that were best correlated with the fibrosis score.
Fifty-nine patients (40.4 %) had severe fibrosis (3 +) while 87 (59.6 %) had no fibrosis or moderate fibrosis (0 to 2 +). In multivariate analysis, serum hyaluronate and the prothrombin index were the best markers for the prediction of severe fibrosis. Hyaluronate and the prothrombin index had a diagnostic accuracy of 91.1 % and 89.7 %, respectively in the whole population. Finally, a significant negative correlation was found between hyaluronate and the prothrombin index (r =- 0.86, P <0.0001).
Using only hyaluronate and the prothrombin index, 9 out of 10 alcoholic patients can be correctly classified according to the severity of liver fibrosis.
本研究旨在评估酒精性肝病中肝纤维化无创标志物的诊断准确性。
对146例连续的重度饮酒者（106例男性，40例女性；平均年龄49.2岁）分析了54项临床和生化参数，包括血清纤维化标志物（透明质酸和转化生长因子β1）。肝脏活检后，使用半定量评分系统（无纤维化（0）至重度纤维化（3 +））评估纤维化情况。进行多变量分析以确定与纤维化评分相关性最佳的标志物。
59例患者（40.4%）有重度纤维化（3 +），而87例（59.6%）无纤维化或有中度纤维化（0至2 +）。在多变量分析中，血清透明质酸和凝血酶原指数是预测重度纤维化的最佳标志物。在总体人群中，透明质酸和凝血酶原指数的诊断准确性分别为91.1%和89.7%。最后，发现透明质酸与凝血酶原指数之间存在显著负相关（r = -0.86，P <0.0001）。
仅使用透明质酸和凝血酶原指数，10例酒精性肝病患者中9例可根据肝纤维化严重程度正确分类。
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