Yilmaz S, Bayan K, Tüzün Y, Dursun M, Kaplan A, Ozmen S, Canoruç F, Akkuş Z
Dicle University, Faculty of Medicine, Department of Gastroenterology, 21280 Diyarbakýr, Turkey.
Int J Clin Pract. 2007 Mar;61(3):438-43. doi: 10.1111/j.1742-1241.2006.00912.x.
Because of limitations in biopsy procedure, several non-invasive tests have been developed for predicting the histological findings in chronic hepatitis. A fibrosis (F) score 1 or above and necroinflammation [histological activity index (HAI)] score 4 or above are required to initiate the treatment in chronic viral hepatitis. Literature includes many studies on hyaluronic acid (HA) as a non-invasive procedure in predicting histological findings but lacks on high-sensitive-C-reactive protein (hsCRP). We evaluated the diagnostic value of HA and hsCRP in patients with chronic viral hepatitis. Ninety-eight subjects (42 chronic viral hepatitis, 28 cirrhosis and 28 healthy controls) were included in the study. Liver biopsies were performed on 42 chronic hepatitis patients and assessed by Ishak scoring system. All sera were stored at -70 degrees C until assay. Many laboratory parameters related to viral hepatitis, HA and hsCRP were studied following the instructions. We tried to determine a cut-off value for HA to represent > or =F1 score and that for hsCRP to represent > or =4 HAI score. Hepatitis B virus was the predominant aetiology of chronic hepatitis in our study. Mean HA levels were 113, 754 and 24 ng/ml in patients with chronic hepatitis, cirrhosis and controls, respectively (anova, p < 0.001). A HA level >64.7 ng/ml had a 100% specificity for diagnosing chronic hepatitis. A value > or =154 ng/ml had a 100% specificity, 100% positive predictive value and 90% negative predictive value for diagnosing liver cirrhosis (Area 1.00; p < 0.0001). A cut-off value of 63 ng/ml for HA had a 100% specificity for diagnosing fibrosis score > or =1 in chronic hepatitis (Area 0.86; p < 0.001). An hsCRP level >0.56 mg/dl had a 100% specificity and 12% sensitivity for diagnosing chronic hepatitis (Area 0.71; p = 0.002), while cut-off of 0.53 mg/dl had 75% specificity for diagnosing HAI > or = 4 in chronic hepatitis (Area 0.32; p = 0.132). This study supported the HA level in predicting fibrosis score > or =1 with a cut-off value of 63 ng/ml. Cut-off of 154 ng/ml had a strong worth for cirrhosis. A cut-off of hsCRP for predicting HAI score > or =4 warrants further evaluation in wider study populations. We concluded that we are a bit closer to the strategy for guiding therapy in patients with chronic hepatitis, without a liver biopsy.
由于活检程序存在局限性，已开发出几种非侵入性检测方法来预测慢性肝炎的组织学结果。在慢性病毒性肝炎中，启动治疗需要纤维化（F）评分1或以上且坏死性炎症[组织学活动指数（HAI）]评分4或以上。文献中有许多关于透明质酸（HA）作为预测组织学结果的非侵入性方法的研究，但缺乏关于高敏C反应蛋白（hsCRP）的研究。我们评估了HA和hsCRP在慢性病毒性肝炎患者中的诊断价值。该研究纳入了98名受试者（42例慢性病毒性肝炎患者、28例肝硬化患者和28名健康对照）。对42例慢性肝炎患者进行了肝活检，并通过Ishak评分系统进行评估。所有血清均在-70℃下保存直至检测。按照说明研究了许多与病毒性肝炎、HA和hsCRP相关的实验室参数。我们试图确定HA的截断值以代表≥F₁评分，以及hsCRP的截断值以代表≥4 HAI评分。在我们的研究中，乙型肝炎病毒是慢性肝炎的主要病因。慢性肝炎患者、肝硬化患者和对照组的平均HA水平分别为113、754和24 ng/ml（方差分析，p<0.001）。HA水平>64.7 ng/ml对诊断慢性肝炎具有100%的特异性。≥154 ng/ml的值对诊断肝硬化具有100%的特异性、100%的阳性预测值和90%的阴性预测值（面积1.00；p<0.0001）。HA的截断值为63 ng/ml对诊断慢性肝炎纤维化评分≥1具有100%的特异性（面积0.86；p<0.001）。hsCRP水平>0.56 mg/dl对诊断慢性肝炎具有100%的特异性和12%的敏感性（面积0.71；p = 0.002），而截断值为0.53 mg/dl对诊断慢性肝炎HAI≥4具有75%的特异性（面积0.32；p = 0.132）。本研究支持HA水平以63 ng/ml的截断值预测纤维化评分≥l。154 ng/ml的截断值对肝硬化具有很强的诊断价值。hsCRP预测HAI评分≥4的截断值值得在更广泛的研究人群中进一步评估。我们得出结论，在不进行肝活检的情况下，我们离指导慢性肝炎患者治疗的策略又近了一步。
