Oregon Health & Science University, Portland, OR 97239, USA.
Ann Intern Med. 2013 Jun 4;158(11):807-20. doi: 10.7326/0003-4819-158-11-201306040-00005.
Many blood tests have been proposed as alternatives to liver biopsy for identifying fibrosis or cirrhosis.
To evaluate the diagnostic accuracy of blood tests to identify fibrosis or cirrhosis in patients with hepatitis C virus (HCV) infection.
MEDLINE (1947 to January 2013), the Cochrane Library, and reference lists.
Studies that compared the diagnostic accuracy of blood tests with that of liver biopsy.
Investigators abstracted and checked study details and quality by using predefined criteria.
172 studies evaluated diagnostic accuracy. For identifying clinically significant fibrosis, the platelet count, age-platelet index, aspartate aminotransferase-platelet ratio index (APRI), FibroIndex, FibroTest, and Forns index had median positive likelihood ratios of 5 to 10 at commonly used cutoffs and areas under the receiver-operating characteristic curve (AUROCs) of 0.70 or greater (range, 0.71 to 0.86). For identifying cirrhosis, the platelet count, age-platelet index, APRI, and Hepascore had median positive likelihood ratios of 5 to 10 and AUROCs of 0.80 or greater (range, 0.80 to 0.91). The Göteborg University Cirrhosis Index and the Lok index had slightly lower positive likelihood ratios (4.8 and 4.4, respectively). In direct comparisons, the APRI was associated with a slightly lower AUROC than the FibroTest for identifying fibrosis and a substantially higher AUROC than the aspartate aminotransferase-alanine aminotransferase ratio for identifying fibrosis or cirrhosis.
Only English-language articles were included, and most studies had methodological limitations, including failure to describe blinded interpretation of liver biopsy specimens and inadequate description of enrollment methods.
Many blood tests are moderately useful for identifying clinically significant fibrosis or cirrhosis in HCV-infected patients.
Agency for Healthcare Research and Quality.
许多血液检测已被提出作为肝活检的替代方法，用于识别纤维化或肝硬化。
评估血液检测在丙型肝炎病毒（HCV）感染患者中识别纤维化或肝硬化的诊断准确性。
MEDLINE（1947 年至 2013 年 1 月）、Cochrane 图书馆和参考文献列表。
比较血液检测与肝活检诊断准确性的研究。
研究人员使用预定义标准提取并检查研究细节和质量。
172 项研究评估了诊断准确性。对于识别临床显著纤维化，血小板计数、年龄-血小板指数、天门冬氨酸氨基转移酶-血小板比率指数（APRI）、FibroIndex、FibroTest 和 Forns 指数在常用临界值下的中位数阳性似然比为 5 至 10，接受者操作特征曲线（AUROC）的面积为 0.70 或更高（范围为 0.71 至 0.86）。对于识别肝硬化，血小板计数、年龄-血小板指数、APRI 和 Hepascore 的中位数阳性似然比为 5 至 10，AUROC 为 0.80 或更高（范围为 0.80 至 0.91）。哥德堡大学肝硬化指数和 Lok 指数的阳性似然比略低（分别为 4.8 和 4.4）。在直接比较中，APRI 与 FibroTest 相比，用于识别纤维化的 AUROC 略低，与天冬氨酸氨基转移酶-丙氨酸氨基转移酶比值相比，用于识别纤维化或肝硬化的 AUROC 显著更高。
仅包括英语文章，并且大多数研究存在方法学局限性，包括未能描述肝活检标本的盲法解释以及对入组方法的描述不充分。
许多血液检测在 HCV 感染患者中用于识别临床显著纤维化或肝硬化具有中等的实用性。
医疗保健研究和质量局。
Zotero 插件