Gebo Kelly A, Chander Geetanjali, Jenckes Mollie W, Ghanem Khalil G, Herlong H Franklin, Torbenson Michael S, El-Kamary Samer S, Bass Eric B
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Hepatology. 2002 Nov;36(5 Suppl 1):S84-92. doi: 10.1053/jhep.2002.36817.
This systematic review addresses the following questions: (1) What is the efficacy of using screening tests for hepatocellular carcinoma (HCC) in improving outcomes in chronic hepatitis C, and (2) what are the sensitivity and specificity of screening tests for HCC in chronic hepatitis C? The search strategy involved searching Medline and other electronic databases between January 1985 and March 2002. Additional articles were identified by reviewing pertinent articles and journals and by querying experts. Articles were eligible for review if they reported original human data from studies of screening tests that used virological, histological, pathologic, or clinical outcome measures. Data collection involved paired reviewers who assessed the quality of each study and abstracted data. One nonrandomized prospective cohort study suggested that HCC was detected earlier and was more often resectable in patients who had twice yearly screening with serum alpha-fetoprotein (AFP) and hepatic ultrasound than in patients who had usual care. Twenty-four studies, which included patients with chronic hepatitis C or B or both, addressed the sensitivities and specificities of screening tests. They were relatively consistent in showing that the sensitivity of serum AFP for detecting HCC usually was moderately high at 45% to 100%, with a specificity of 70% to 95%, for a threshold of between 10 and 19 ng/mL. The few studies that evaluated screening with ultrasound reported high specificity, but variable sensitivity. In conclusion, screening of patients with chronic hepatitis C with AFP and ultrasound may improve detection of HCC, but studies are needed to determine whether screening improves clinical outcomes.
（1）使用肝细胞癌（HCC）筛查试验对改善慢性丙型肝炎患者的预后有何疗效，以及（2）慢性丙型肝炎患者HCC筛查试验的敏感性和特异性如何？检索策略包括检索1985年1月至2002年3月期间的Medline及其他电子数据库。通过查阅相关文章和期刊以及咨询专家确定了其他文章。如果文章报告了使用病毒学、组织学、病理学或临床结局指标的筛查试验研究中的原始人体数据，则符合纳入综述的条件。数据收集由配对的评审员进行，他们评估每项研究的质量并提取数据。一项非随机前瞻性队列研究表明，与接受常规治疗的患者相比，每年接受两次血清甲胎蛋白（AFP）和肝脏超声筛查的患者中HCC被更早发现且更常可切除。24项研究纳入了慢性丙型肝炎或慢性乙型肝炎患者或两者均有的患者，探讨了筛查试验的敏感性和特异性。这些研究相对一致地表明，血清AFP检测HCC的敏感性通常中等偏高，为45%至100%，特异性为70%至95%，阈值为10至19 ng/mL。少数评估超声筛查的研究报告了高特异性，但敏感性各不相同。总之，对慢性丙型肝炎患者进行AFP和超声筛查可能会改善HCC的检出，但仍需开展研究以确定筛查是否能改善临床结局。
