Chiquete Erwin, Sánchez Laura V, Maldonado Montserrat, Quezada Daniel, Panduro Arturo
Department of Molecular Biology in Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde México.
Ann Hepatol. 2005 Apr-Jun;4(2):107-14.
Detection of anti-hepatitis C virus (anti-HCV) antibodies may yield a high frequency of false-positive results in people at low risk. To date, no clinical rule had been developed to predict viremia in HCV-seropositive patients. Therefore, we aimed to generate a prediction rule on the basis of clinical and serologic data, which can be used in outpatient care. We selected 114 seropositive patients without antiviral treatment or hepatitis B coinfection. Subsequently we identified independent predictors of the hepatitis C viremia by logistic regression and selected the quantitative value of the screening test for anti-HCV antibodies with the best performance in detecting viremia. Then, we combined clinical and serologic data to generate different prediction rules. Ratio of immunoassay signal strength of the sample to cut-off (S/CO) >15 had accuracy, positive predictive value (PPV) and positive likelihood ratio (LR+) of 84%, 83%, and 3.7; respectively. The rule compounded of the antecedent of blood transfusion before 1993 and S/CO >15 performed the best in prediction of viremia in all patients, with accuracy, PPV and LR+ of 71%, 88%, and 5.6; respectively. In the group of asymptomatic patients this rule improved in efficacy of prediction, with accuracy, PPV and LR+ of 79%, 91% and 12.8; respectively. In conclusion, a clinical rule is better than S/CO alone in prediction of the hepatitis C viremia. In a patient that meet the rule the probability of having viremia is high, therefore, it can be indicated directly an assay for viral load instead of other supplemental tests, thus, saving time and economic resources.
在低风险人群中，抗丙型肝炎病毒（抗-HCV）抗体检测可能会产生较高频率的假阳性结果。迄今为止，尚未制定出用于预测HCV血清学阳性患者病毒血症的临床规则。因此，我们旨在基于临床和血清学数据生成一种预测规则，可用于门诊护理。我们选择了114例未接受抗病毒治疗或未合并乙型肝炎感染的血清学阳性患者。随后，我们通过逻辑回归确定丙型肝炎病毒血症的独立预测因素，并选择在检测病毒血症方面表现最佳的抗-HCV抗体筛查试验的定量值。然后，我们结合临床和血清学数据生成不同的预测规则。样本免疫测定信号强度与临界值之比（S/CO）>15时，准确率、阳性预测值（PPV）和阳性似然比（LR+）分别为84%、83%和3.7。由1993年前输血史和S/CO>15组成的规则在所有患者的病毒血症预测中表现最佳，准确率、PPV和LR+分别为71%、88%和5.6。在无症状患者组中，该规则的预测效能有所提高，准确率、PPV和LR+分别为79%、91%和12.8。总之，在预测丙型肝炎病毒血症方面，临床规则比单独的S/CO更好。对于符合该规则的患者，出现病毒血症的可能性很高，因此，可以直接进行病毒载量检测，而无需进行其他补充检测，从而节省时间和经济资源。
