Myers Robert P, De Torres Mercedes, Imbert-Bismut Françoise, Ratziu Vlad, Charlotte Frédéric, Poynard Thierry
Department of Gastroenterology and Hepatology, Groupe Hospitalier Pitié-Salpêtriére, Paris, France.
Dig Dis Sci. 2003 Jan;48(1):146-53. doi: 10.1023/a:1021702902681.
As an alternative to liver biopsy, an index of five biochemical markers (alpha2-macroglobulin, apolipoprotein A1, haptoglobin, total bilirubin, gamma-glutamyl-transpeptidase) has been shown to predict the severity of hepatitis C-related fibrosis. The objective of this study was to compare this index with other markers frequently used for this purpose (prothrombin time, platelets, age-platelet index). In 323 hepatitis C-infected patients, the discriminative values of these markers for F2-F4 fibrosis (by the METAVIR classification) were compared. By multiple logistic regression analysis, only the five-marker index (P < 0.0001) and prothrombin time (P = 0.02) were independently predictive of F2-F4 fibrosis. For this outcome, the area under the receiver operating characteristic curve was significantly higher for the five-marker index (0.836 +/- 0.024) than the age-platelet index (P = 0.002), and the platelet count and prothrombin time (P < 0.001), indicating greater diagnostic value. The addition of the latter markers to the five-marker index proved unhelpful for increasing its accuracy. In conclusion, an index of five biochemical markers accurately predicts significant hepatitis C-related fibrosis and is superior to traditional markers.
作为肝活检的替代方法，一种由五种生化标志物（α2-巨球蛋白、载脂蛋白A1、触珠蛋白、总胆红素、γ-谷氨酰转肽酶）组成的指标已被证明可预测丙型肝炎相关纤维化的严重程度。本研究的目的是将该指标与常用于此目的的其他标志物（凝血酶原时间、血小板、年龄-血小板指数）进行比较。在323例丙型肝炎感染患者中，比较了这些标志物对F2-F4纤维化（根据METAVIR分类）的判别价值。通过多因素逻辑回归分析，只有五标志物指标（P<0.0001）和凝血酶原时间（P=0.02）可独立预测F2-F4纤维化。对于这一结果，五标志物指标的受试者工作特征曲线下面积（0.836±0.024）显著高于年龄-血小板指数（P=0.002），以及血小板计数和凝血酶原时间（P<0.001），表明其诊断价值更大。将后几种标志物添加到五标志物指标中并不能提高其准确性。总之，一种由五种生化标志物组成的指标可准确预测显著的丙型肝炎相关纤维化，且优于传统标志物。
