Winkel P, Ramsoe K, Lyngbye J, Tygstrup N
Clin Chem. 1975 Jan;21(1):71-5.
In 131 patients on a medical service and 97 patients on a surgical service, in whom a diagnosis of hepatobiliary disease was verified in the hospital, the diagnostic value of routine liver tests performed soon after admission was evaluated by stepwise discriminant analysis. By measurements of alanine aminotransferase, alkaline phosphatases, gamma globulin, prothrombin time, bilirubin, and albumin, half of the medical patients were correctly classified into one of seven diagnostic categories. Aminotransferase contributed most to the classification, being twice as effective as random allocation. Decreasing the number of diagnostic categories to three (hepatitis, fatty liver, and chronic liver disease) increased the frequency of correct allocation to 80%. The allocation of all the patients to seven medical and four surgical diagnostic categories by means of four tests (aminotransferase, alkaline phosphatases, prothrombin time, and bilirubin) was significantly improved by each step with a misclassification rate of 55% when all tests were used. A reduction of the diagnostic groups to five (hepatitis, fatty liver, chronic liver disease, duct obstruction and tumor) increased the frequency of correct allocation to 63%. The analysis demonstrates the limited diagnostic effectiveness of routine liver tests when used alone. The absolute discrimination values depend on the a priori frequencies of the diagnostic groups investigated, and therefore may vary from time to time and from place to place.
在131名内科患者和97名外科患者中（这些患者在医院确诊为肝胆疾病），通过逐步判别分析评估入院后不久进行的常规肝功能检查的诊断价值。通过测量谷丙转氨酶、碱性磷酸酶、γ球蛋白、凝血酶原时间、胆红素和白蛋白，一半的内科患者被正确分类到七个诊断类别之一。谷丙转氨酶对分类的贡献最大，其有效性是随机分配的两倍。将诊断类别减少到三个（肝炎、脂肪肝和慢性肝病），正确分配的频率提高到80%。通过四项检查（谷丙转氨酶、碱性磷酸酶、凝血酶原时间和胆红素）将所有患者分配到七个内科和四个外科诊断类别中，每一步都有显著改善，当使用所有检查时错误分类率为55%。将诊断组减少到五个（肝炎、脂肪肝、慢性肝病、胆管梗阻和肿瘤），正确分配的频率提高到63%。分析表明单独使用常规肝功能检查诊断效果有限。绝对判别值取决于所研究诊断组的先验频率，因此可能随时间和地点而变化。
