Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B

被引:294
作者
Myers, RP
Tainturier, MH
Ratziu, V
Piton, A
Thibault, V
Imbert-Bismut, F
Messous, D
Charlotte, F
Di Martino, V
Benhamou, Y
Poynard, T
机构
[1] Grp Hosp Pitie Salpetriere, Dept Gastroenterol & Hepatol, F-75651 Paris 13, France
[2] Grp Hosp Pitie Salpetriere, Dept Biochem, F-75651 Paris 13, France
[3] Grp Hosp Pitie Salpetriere, Dept Virol, F-75651 Paris 13, France
[4] Grp Hosp Pitie Salpetriere, Dept Pathol, F-75651 Paris 13, France
基金
加拿大健康研究院;
关键词
alpha-macroglobulins; apolipoprotein A1; biopsy; diagnosis; fibrosis; haptoglobins; histology; hepatitis B; receiver operating characteristic curve; transaminases;
D O I
10.1016/S0168-8278(03)00171-5
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Aims: Liver biopsy is the gold standard for assessing hepatitis B virus (HBV)-related histology. The aim was to determine the diagnostic utility of noninvasive serum markers in patients with chronic hepatitis B. Methods: The aminotransferases and indices including alpha(2)-macroglobulin, apolipoprotein A1, haptoglobin, gamma-glutamyl-transpeptidase (GGT), and total bilirubin (Fibrotest), and ALT (Actitest) were compared with liver histology. The primary outcomes were A2-A3 activity and F2-F4 fibrosis (METAVIR). Results: Two hundred and nine patients were included. Forty-one patients (20%) had A2-A3 activity and 61 (29%) had F2-F4 fibrosis. AST and GGT (P < 0.001) were independently associated with A2-A3 activity. AST, ALT, and Actitest accurately predicted activity ((areas under receiver operating characteristic (ROC) curves (AUROC), 0.81-0.82 +/- 0.04)); an AST or ALT <= 30 IU/l excluded significant activity with 96% certainty. Fibrotest accurately predicted F2-F4 fibrosis (AUROC, 0.78 +/- 0.04). Fibrotest scores (range, 0-1.0) <= 0.20 and >0.80 had negative and positive predictive values of 92%, respectively. Restricting biopsy to patients with intermediate scores (>0.20 and less than or equal to0.80) may prevent liver biopsies in 46 % of patients while maintaining 92 % accuracy. Conclusions: The aminotransferases and an index including five biochemical markers are accurate noninvasive markers of HBV-related activity and fibrosis, respectively. (C) 2003 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.
引用
收藏
页码:222 / 230
页数:9
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