Hepatology Department, Derriford Hospital, Plymouth, UK.
J Viral Hepat. 2010 Aug;17(8):546-54. doi: 10.1111/j.1365-2893.2009.01210.x. Epub 2009 Oct 27.
Historically, liver biopsy (LB) was the sole method to evaluate the severity of hepatic fibrosis in patients with chronic hepatitis C infection. However, LB is expensive and associated with a risk of severe complications. Therefore, noninvasive tests have been developed to assess the severity of liver fibrosis. The accuracy of Fibroscan (FS) and King's score (KS) was evaluated individually and in combination using liver histology as the reference standard. One hundred and eighty-seven patients were identified who had undergone a biopsy with a diagnosis of chronic hepatitis C virus (HCV) mono-infection (HCV RNA-positive by RT-PCR), attending King's College Hospital (n = 88) or the Royal Free Hospital (n = 99) (London) between May 2006 and December 2007. Liver fibrosis was scored using the Ishak method; significant fibrosis was defined as Ishak fibrosis stage F3-F6, and cirrhosis defined as Ishak fibrosis F5-F6. The diagnostic accuracy of each test was assessed by area under receiver operator characteristic curves (AUROC). Median age was 49 years (43-54) and 115 (61%) were male. The AUROC for FS, KS and FS + KS for the diagnosis of Ishak F3-F6 were 0.83, 0.82 and 0.85, respectively and for the diagnosis of cirrhosis (>or=F5) were 0.96, 0.89 and 0.93, respectively. The negative predictive values for the diagnosis of cirrhosis using the optimal cut-off results for fibrsocan (10.05 kPa), KS (24.3) and the two combined (26.1) were 98%, 91% and 94%, respectively. The noninvasive markers and, particularly, FS were effective tests for the prediction of cirrhosis in chronic hepatitis C. Both KS and FS also had clinical utility for the prediction of Ishak fibrosis stages F3-F6.
从历史上看，肝活检（LB）是评估慢性丙型肝炎感染患者肝纤维化严重程度的唯一方法。然而，LB 费用昂贵且存在严重并发症的风险。因此，已经开发了非侵入性测试来评估肝纤维化的严重程度。单独评估了 Fibroscan（FS）和 King 评分（KS）的准确性，并结合肝组织学作为参考标准进行了评估。确定了 187 名接受了诊断为慢性丙型肝炎病毒（HCV）单感染（通过 RT-PCR 检测到 HCV RNA 阳性）的患者的肝活检，这些患者于 2006 年 5 月至 2007 年 12 月在 King's College Hospital（n = 88）或 Royal Free Hospital（n = 99）（伦敦）就诊。使用 Ishak 方法对肝纤维化进行评分；显著纤维化定义为 Ishak 纤维化分期 F3-F6，肝硬化定义为 Ishak 纤维化 F5-F6。通过接收者操作特征曲线下面积（AUROC）评估每种测试的诊断准确性。中位年龄为 49 岁（43-54），115 名（61%）为男性。FS、KS 和 FS+KS 对 Ishak F3-F6 诊断的 AUROC 分别为 0.83、0.82 和 0.85，对肝硬化（>or=F5）的诊断 AUROC 分别为 0.96、0.89 和 0.93。使用 Fibroscan（10.05 kPa）、KS（24.3）和两者结合（26.1）的最佳截断值，肝硬化诊断的阴性预测值分别为 98%、91%和 94%。非侵入性标志物，特别是 FS，是慢性丙型肝炎肝硬化预测的有效检测方法。KS 和 FS 对预测 Ishak 纤维化分期 F3-F6 也具有临床实用性。
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