Diagnostic accuracy of a fibrosis serum panel (FIBROSpect II) compared with Knodell and Ishak liver biopsy scores in chronic hepatitis C patients

被引:44
作者
Christensen, C.
Bruden, D.
Livingston, S.
Deubner, H.
Homan, C.
Smith, K.
Oh, E.
Gretch, D.
Williams, J.
McMahon, B.
机构
[1] Alaska Nat Tribal Hlth Consortium, Liver Dis & Hepatitis Program, Anchorage, AK USA
[2] Ctr Dis Control & Prevent, Arctic Invest Program, Anchorage, AK USA
[3] Univ Washington, Sch Med, Seattle, WA USA
[4] Prometheus Labs Inc, San Diego, CA USA
关键词
hepatitis C; liver biopsy; liver fibrosis; serodiagnostic panel;
D O I
10.1111/j.1365-2893.2006.00743.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Liver biopsy is the primary method of assessing liver injury in hepatitis C patients. FIBROSpect II (FS), a diagnostic panel of three extracellular matrix remodelling markers, may be useful as a noninvasive alternative to this procedure. The purpose of this study was to correlate FS results with liver fibrosis scores to determine if this test is sufficiently accurate to be a viable alternative to liver biopsy. A total of 142 serum specimens were evaluated for fibrosis with FS and were compared with Knodell and Ishak fibrosis scores. FS reports an index score ranging from 0.1 to 1.0, which corresponds to the probability of progressive liver fibrosis. Using a FS index cut-off of 0.42, 50 of 54 patients with Ishak 3-6 were classified as having advanced fibrosis (METAVIR F2-F4) and 58 of 88 patients with Ishak 0-2 as having no/mild fibrosis (METAVIR F0-F1), resulting in a sensitivity of 93%, specificity of 66%, and an overall test accuracy of 76%. With a 38% prevalence of advanced fibrosis, the negative predictive value was 94% and positive predictive value was 63%. A biopsy length of >= 2 cm was associated with higher concordance between FS results and liver fibrosis scores (P = 0.01). FS was clinically useful in ruling out advanced fibrosis in hepatitis C by identifying patients with mild disease in whom treatment could be deferred. The limitation of this test is its decreased sensitivity and specificity in the middle of the test's reporting range between scores of 0.42 and 0.80.
引用
收藏
页码:652 / 658
页数:7
相关论文
共 16 条
[1]   The prevalence of hepatitis C virus infection in the United States, 1988 through 1994 [J].
Alter, MJ ;
Kruszon-Moran, D ;
Nainan, OV ;
McQuillan, GM ;
Gao, FX ;
Moyer, LA ;
Kaslow, RA ;
Margolis, HS .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 341 (08) :556-562
[2]  
[Anonymous], 2002, NIH Consens State Sci Statements, V19, P1
[3]   An algorithm for the grading of activity in chronic hepatitis C [J].
Bedossa, P ;
Poynard, T .
HEPATOLOGY, 1996, 24 (02) :289-293
[4]   Sampling variability of liver fibrosis in chronic hepatitis C [J].
Bedossa, P ;
Dargère, D ;
Paradis, V .
HEPATOLOGY, 2003, 38 (06) :1449-1457
[5]   Morbidity and mortality in compensated cirrhosis type C: A retrospective follow-up study of 384 patients [J].
Fattovich, G ;
Giustina, G ;
Degos, F ;
Tremolada, F ;
Diodati, G ;
Almasio, P ;
Nevens, F ;
Solinas, A ;
Mura, D ;
Brouwer, JT ;
Thomas, H ;
Njapoum, C ;
Casarin, C ;
Bonetti, P ;
Fuschi, P ;
Basho, J ;
Tocco, A ;
Bhalla, A ;
Galassini, R ;
Noventa, F ;
Schalm, SW ;
Realdi, G .
GASTROENTEROLOGY, 1997, 112 (02) :463-472
[6]   INDICATIONS, METHODS, AND OUTCOMES OF PERCUTANEOUS LIVER-BIOPSY IN ENGLAND AND WALES - AN AUDIT BY THE BRITISH-SOCIETY-OF-GASTROENTEROLOGY AND THE ROYAL-COLLEGE-OF-PHYSICIANS-OF-LONDON [J].
GILMORE, IT ;
BURROUGHS, A ;
MURRAYLYON, IM ;
WILLIAMS, R ;
JENKINS, D ;
HOPKINS, A .
GUT, 1995, 36 (03) :437-441
[7]   The long-term outcomes of patients with compensated hepatitis C virus-related cirrhosis and history of parenteral exposure in the United States [J].
Hu, KQ ;
Tong, MJ .
HEPATOLOGY, 1999, 29 (04) :1311-1316
[8]   A comparison in the progression of liver fibrosis in chronic hepatitis C between persistently normal and elevated transaminase [J].
Hui, CK ;
Belaye, T ;
Montegrande, K ;
Wright, TL .
JOURNAL OF HEPATOLOGY, 2003, 38 (04) :511-517
[9]   HISTOLOGICAL GRADING AND STAGING OF CHRONIC HEPATITIS [J].
ISHAK, K ;
BAPTISTA, A ;
BIANCHI, L ;
CALLEA, F ;
DEGROOTE, J ;
GUDAT, F ;
DENK, H ;
DESMET, V ;
KORB, G ;
MACSWEEN, RNM ;
PHILLIPS, MJ ;
PORTMANN, BG ;
POULSEN, H ;
SCHEUER, PJ ;
SCHMID, M ;
THALER, H .
JOURNAL OF HEPATOLOGY, 1995, 22 (06) :696-699
[10]   FORMULATION AND APPLICATION OF A NUMERICAL SCORING SYSTEM FOR ASSESSING HISTOLOGICAL ACTIVITY IN ASYMPTOMATIC CHRONIC ACTIVE HEPATITIS [J].
KNODELL, RG ;
ISHAK, KG ;
BLACK, WC ;
CHEN, TS ;
CRAIG, R ;
KAPLOWITZ, N ;
KIERNAN, TW ;
WOLLMAN, J .
HEPATOLOGY, 1981, 1 (05) :431-435