Gordon Adam, Bailey Michael J, Gibson Peter R, Roberts Stuart K
Department of Gastroenterology, Alfred Hospital, Commercial Road, Prahran, Victoria 3181, Australia.
J Gastroenterol Hepatol. 2005 Jun;20(6):825-32. doi: 10.1111/j.1440-1746.2005.03828.x.
The diagnosis of cirrhosis in chronic hepatitis C (CHC) is important but difficult in those who are unable to undergo liver biopsy. Thus, the aims of the present study were to compare separately and in combination, clinical markers of liver disease, the discriminant score (DS) and serum hyaluronic acid (HA) for their ability to predict cirrhosis in CHC.
Two groups of consecutive patients (groups 1 and 2) with CHC were analyzed. Clinical data and routine laboratory results at the time of liver biopsy were collected, and serum HA levels were assayed. A clinical examination score (CES) was constructed using the sum of clinical markers of liver disease in group 1 and was validated in group 2, the DS was calculated, and a serum HA score (HAS) was produced. Combination scores were constructed using the sum of the CES, DS and HAS. Histological analysis of liver biopsies was performed by hepatopathologists blinded to clinical results.
One hundred and fifty-one patients with CHC (group 1, n = 47; group 2, n = 104) including 27 with cirrhosis were assessed. Serum HA was more accurate than either CES or DS in the prediction of cirrhosis. The combination of CES, DS and HAS enabled the most accurate prediction of cirrhosis with a sensitivity and specificity of 78% and 93%, and a positive predictive value and negative predictive value of 75% and 94%, respectively.
A comprehensive clinical assessment utilizing clinical and laboratory data more accurately predicts the presence and absence of cirrhosis in CHC than individual markers.
在慢性丙型肝炎（CHC）患者中，肝硬化的诊断很重要，但对于那些无法进行肝活检的患者来说却很困难。因此，本研究的目的是分别比较和联合比较肝病的临床标志物、判别评分（DS）和血清透明质酸（HA）预测CHC患者肝硬化的能力。
分析两组连续的CHC患者（第1组和第2组）。收集肝活检时的临床数据和常规实验室结果，并检测血清HA水平。使用第1组肝病临床标志物的总和构建临床检查评分（CES），并在第2组中进行验证，计算DS，并得出血清HA评分（HAS）。使用CES、DS和HAS的总和构建联合评分。肝活检的组织学分析由对临床结果不知情的肝病病理学家进行。
评估了151例CHC患者（第1组，n = 47；第2组，n = 104），其中27例患有肝硬化。在预测肝硬化方面，血清HA比CES或DS更准确。CES、DS和HAS的联合能够最准确地预测肝硬化，敏感性和特异性分别为78%和93%，阳性预测值和阴性预测值分别为75%和94%。
与单个标志物相比，利用临床和实验室数据进行的综合临床评估能更准确地预测CHC患者是否存在肝硬化。
