Giannini Edoardo, Botta Federica, Testa Emanuela, Romagnoli Paola, Polegato Simone, Malfatti Federica, Fumagalli Alessandra, Chiarbonello Bruno, Risso Domenico, Testa Roberto
Department of Internal Medicine, University of Genoa, Italy.
Am J Gastroenterol. 2002 Nov;97(11):2855-60. doi: 10.1111/j.1572-0241.2002.07053.x.
The AST/ALT ratio has shown good diagnostic accuracy in patients with chronic viral liver disease. However, its prognostic utility has never been tested. Recently, the Model for End-Stage Liver Disease (MELD) has been proposed as a simple and effective tool to predict survival in patients with liver cirrhosis. The aims of this study were to assess the 3-month and 1-yr prognostic ability of the AST/ALT ratio in a series of patients with virus-related liver cirrhosis, and to evaluate the relationship between the AST/ALT ratio and the MELD score and to compare their prognostic ability.
The AST/ALT ratios and MELD scores of 99 patients with liver cirrhosis of viral etiology (73 patients with hepatitis C virus and 26 with hepatitis B virus) who had been followed-up for at least 1 yr were retrospectively calculated and correlated with the patients' 3-month and 1-yr prognosis. Receiver operating characteristic curves were used to determine the AST/ALT ratio and the MELD score cut-offs with the best sensitivity (SS) and specificity (SP) in discriminating between patients who survived and those who died. Univariate survival curves were estimated by the Kaplan-Meier method using the cut-offs identified by means of receiver operating characteristic curves.
AST/ALT ratios and MELD scores showed a significant correlation (r(s) = 0.503, p = 0.0001). In all, 8% and 30% of the patients had died after 3 months and 1 yr of follow-up, respectively. AST/ALT ratios and MELD scores were significantly higher among the patients who died during both 3-month and 1-yr follow-up. An AST/ALT ratio cut-off of 1.17 had 87% SS and 52% SP, whereas a MELD cut-off of 9 had 57% SS and 74% SP in discriminating between patients who survived and those who died after I yr. The combined assessment of the AST/ALT ratio and/or MELD score had 90% SS and 78% SP. Survival curves of the patients showed that both parameters clearly discriminated between patients who survived and those who died in the short term (AST/ALT ratio, p = 0.0094; MELD score, p = 0.0089) as well as in the long term (AST/ALT ratio, p < 0.0005; MELD score, p = 0.004).
In patients with virus-related cirrhosis, the AST/ALT ratio has prognostic capability that is not significantly different from that of an established prognostic score such as MELD. Combined assessment of the two parameters increases the medium-term prognostic accuracy.
天冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）比值在慢性病毒性肝病患者中显示出良好的诊断准确性。然而，其预后价值从未得到验证。最近，终末期肝病模型（MELD）已被提出作为预测肝硬化患者生存的一种简单有效的工具。本研究的目的是评估一系列病毒相关性肝硬化患者中AST/ALT比值的3个月和1年预后能力，评估AST/ALT比值与MELD评分之间的关系，并比较它们的预后能力。
回顾性计算99例病毒病因所致肝硬化患者（73例丙型肝炎病毒患者和26例乙型肝炎病毒患者）的AST/ALT比值和MELD评分，这些患者至少随访了1年，并将其与患者的3个月和1年预后相关联。采用受试者工作特征曲线来确定在区分存活患者和死亡患者时具有最佳敏感性（SS）和特异性（SP）的AST/ALT比值和MELD评分临界值。使用通过受试者工作特征曲线确定的临界值，采用Kaplan-Meier方法估计单因素生存曲线。
AST/ALT比值与MELD评分呈显著相关性（r(s)=0.503，p = 0.0001）。总共8%和30%的患者在随访3个月和1年后死亡。在3个月和1年随访期间死亡的患者中，AST/ALT比值和MELD评分显著更高。在区分1年后存活患者和死亡患者时，AST/ALT比值临界值为1.17时，敏感性为87%，特异性为52%；而MELD临界值为9时，敏感性为57%，特异性为74%。AST/ALT比值和/或MELD评分的联合评估敏感性为90%，特异性为78%。患者的生存曲线表明，这两个参数在短期（AST/ALT比值，p = 0.0094；MELD评分，p = 0.0089）和长期（AST/ALT比值，p < 0.0005；MELD评分，p = 0.004）都能清楚地区分存活患者和死亡患者。
在病毒相关性肝硬化患者中，AST/ALT比值具有预后能力，与诸如MELD等既定的预后评分相比无显著差异。两个参数的联合评估可提高中期预后准确性。
