摘要
AIM:To formulate a noninvasive index predictive of se-verity of liver f ibrosis and activity in chronic hepatitis C.METHODS:This cross sectional study was conducted on polymerase chain reaction positive,treatment nave patients.Fibrosis was staged on a f ive point scale from F0-F4 and activity was graded on a four point scale from A0-A3,according to the METAVIR system.Patients were divided into two overall severity groups,minimal disease(< F2 and < A2)and signif icant disease(≥ F2 or ≥ A2).Eleven markers were measured in blood.Sta-tistically,the primary outcome variable was identif ica-tion of minimal and signif icant overall disease.Indices were formulated using β regression values of different combinations of nine statistically significant factors.Diagnostic performance of these indices was assessed through receiver-operating characteristic curve analysis.RESULTS:A total of 98 patients were included and of these 46 had an overall clinically significant disease.Our f inal six marker index,Liverscore for Hepatitis C,consisted of age,alanine transaminase,gamma-gluta-myl transpeptidase,apolipoprotein A-1,alpha-2 macro-globulin and hyaluronic acid.The area under the curve was found to be 0.813.On a 0-1 scale,negative predic-tive value at a cutoff level of ≤ 0.40 was 83%,while positive predictive value at ≥ 0.80 remained 89%.Al-together,61% of the patients had these discriminative scores.CONCLUSION:This index is discriminative of minimal and significant overall liver disease in a majority of chronic hepatitis C patients and can help in clinical de-cision making.
AIM：To formulate a noninvasive index predictive of se-verity of liver f ibrosis and activity in chronic hepatitis C.METHODS：This cross sectional study was conducted on polymerase chain reaction positive,treatment nave patients.Fibrosis was staged on a f ive point scale from F0-F4 and activity was graded on a four point scale from A0-A3,according to the METAVIR system.Patients were divided into two overall severity groups,minimal disease（〈 F2 and 〈 A2）and signif icant disease（≥ F2 or ≥ A2）.Eleven markers were measured in blood.Sta-tistically,the primary outcome variable was identif ica-tion of minimal and signif icant overall disease.Indices were formulated using β regression values of different combinations of nine statistically significant factors.Diagnostic performance of these indices was assessed through receiver-operating characteristic curve analysis.RESULTS：A total of 98 patients were included and of these 46 had an overall clinically significant disease.Our f inal six marker index,Liverscore for Hepatitis C,consisted of age,alanine transaminase,gamma-gluta-myl transpeptidase,apolipoprotein A-1,alpha-2 macro-globulin and hyaluronic acid.The area under the curve was found to be 0.813.On a 0-1 scale,negative predic-tive value at a cutoff level of ≤ 0.40 was 83%,while positive predictive value at ≥ 0.80 remained 89%.Al-together,61% of the patients had these discriminative scores.CONCLUSION：This index is discriminative of minimal and significant overall liver disease in a majority of chronic hepatitis C patients and can help in clinical de-cision making.
基金
Supported by Ziauddin University,Karachi and Pakistan Medical Research Council,Islamabad
