Luo Jiing-Chyuan, Hwang Shinn-Jang, Chang Full-Young, Chu Chen-Wei, Lai Chiung-Ru, Wang Yuan-Jen, Lee Pui-Ching, Tsay Shyh-Haw, Lee Shou-Dong
Division of Gastroenterology, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Hepatogastroenterology. 2002 Mar-Apr;49(44):478-81.
BACKGROUND/AIMS: Twenty to fifty percent of patients with chronic hepatitis C virus infection will insidiously progress to cirrhosis after 10-20 years' follow-up. The aim of this study is to retrospectively evaluate the role of simple non-invasive blood tests in detecting the presence of compensated liver cirrhosis in Chinese patients with chronic hepatitis C.
One hundred and eleven biopsy-proven chronic hepatitis C patients were enrolled, 23 (20.7%) patients showed cirrhosis with class A in Child-Pugh's classification and were all asymptomatic. Liver biochemistry, complete blood count, and serum N-terminal propeptide of type III procollagen were determined and then compared between chronic hepatitis C patients with compensated cirrhosis and without cirrhosis. Multivariate logistic regression analysis was used to predict factors associated with compensated cirrhosis.
Multivariate logistic regression analysis showed platelet count < or = 140,000/mm3 (odds ratio: 23.44, P < 0.001), globulin/albumin ratio > or = 1 (odds ratio: 31.47, P = 0.008), and AST/ALT ratio > or = (odds ratio: 6.58, P = 0.035) were significant predictors associated with hepatitis C virus-related compensated cirrhosis. Platelet count < or = 140,000/mm3 had 83% sensitivity and 85% specificity in detecting liver cirrhosis. Globulin/albumin ratio > or = 1 had 43% sensitivity, 98% specificity and AST/ALT ratio > or = 1 had 39% sensitivity, 92% specificity in detecting liver cirrhosis. Combined tests with AST/ALT > or = 1 and globulin/albumin > or = 1, platelet count < or = 140,000/mm3 and globulin/albumin > or = 1 had 100% specificity, 100% positive predictive value but lower sensitivity (22% and 39% respectively), lower negative predictive value (83% and 86%, respectively) in detecting hepatitis C virus-related compensated liver cirrhosis.
Simple blood tests with platelet count < or = 140,000/mm3, globulin/albumin ratio > or = 1, and AST/ALT ratio > or = 1 can indicate liver cirrhosis in follow-up patients with chronic hepatitis C.
背景/目的：20%至50%的慢性丙型肝炎病毒感染患者在经过10至20年的随访后会不知不觉地发展为肝硬化。本研究的目的是回顾性评估简单的非侵入性血液检测在中国慢性丙型肝炎患者中检测代偿期肝硬化存在情况的作用。
纳入111例经活检证实的慢性丙型肝炎患者，其中23例（20.7%）患者在Child-Pugh分级中显示为A级肝硬化，且均无症状。测定了肝脏生化指标、全血细胞计数和血清III型前胶原N端前肽，然后对代偿期肝硬化的慢性丙型肝炎患者和无肝硬化的患者进行比较。采用多因素逻辑回归分析来预测与代偿期肝硬化相关的因素。
多因素逻辑回归分析显示，血小板计数≤140,000/mm3（比值比：23.44，P<0.001）、球蛋白/白蛋白比值≥1（比值比：31.47，P = 0.008）以及AST/ALT比值≥1（比值比：6.58，P = 0.035）是与丙型肝炎病毒相关的代偿期肝硬化相关的显著预测因素。血小板计数≤140,000/mm3在检测肝硬化方面具有83%的敏感性和85%的特异性。球蛋白/白蛋白比值≥1在检测肝硬化方面具有43%的敏感性、98%的特异性，AST/ALT比值≥1在检测肝硬化方面具有39%的敏感性、92%的特异性。AST/ALT≥1和球蛋白/白蛋白≥1联合检测、血小板计数≤140,000/mm3和球蛋白/白蛋白≥1联合检测在检测丙型肝炎病毒相关的代偿期肝硬化时具有100%的特异性、100%的阳性预测值，但敏感性较低（分别为22%和39%），阴性预测值也较低（分别为83%和86%）。
血小板计数≤140,000/mm3、球蛋白/白蛋白比值≥1以及AST/ALT比值≥1的简单血液检测可提示慢性丙型肝炎随访患者存在肝硬化。
