纤维化的超声无创和标记的精度识别肝硬化患者

StephenW

June 2015, Volume 60, Issue 6, pp 1841-1847
Date: 14 Jan 2015
Accuracy of Ultrasound and Noninvasive Markers of Fibrosis to Identify Patients with Cirrhosis

    Jason Martin, Gaurav Khatri, Purva Gopal, Amit G. Singal



        1. Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, TX, USA
        2. Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
        3. Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
        4. Division of Digestive and Liver Diseases, Dedman Scholar of Clinical Care, University of Texas Southwestern, 5959 Harry Hines Blvd, POB 1, Suite 420, Dallas, TX, 75390-8887, USA


Abstract
Background

Accurate identification of patients with cirrhosis using noninvasive markers of fibrosis is useful for esophageal varices and hepatocellular carcinoma surveillance programs. The aims of our study were to characterize the accuracy of ultrasonography, AST-to-platelet ratio index (APRI), and FIB-4 as noninvasive markers to identify the presence of cirrhosis.
Methods

We conducted a retrospective cohort study of patients who underwent liver biopsy at a large urban safety-net institution between November 2008 and July 2011. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and overall accuracy using receiver operator characteristic curve analysis for the detection of cirrhosis were calculated for each noninvasive marker.
Results

Liver biopsy was performed in 388 patients, of whom 93 (24.0 %) had cirrhosis. C-statistics for APRI and FIB-4 predicting the presence of cirrhosis were 0.68 (95 % CI 0.63–0.74) and 0.73 (95 % CI 0.68–0.78), respectively. The c-statistic for a nodular appearance on ultrasound was 0.78 (95 % CI 0.72–0.83). The PPV of a shrunken nodular-appearing liver was 64.8 %; however, PPV was significantly higher in the subset with a cirrhotic-appearing liver and signs of portal hypertension (PPV 83.6 %, p = 0.01) as well as in the subset with a noninvasive fibrosis marker also suggesting cirrhosis (PPV 77.8 %, p < 0.001).
Conclusion

Serum and imaging noninvasive markers of fibrosis may have insufficient accuracy when used in isolation; however, a combination of markers may allow sufficient accuracy to systematically identify patients with cirrhosis.

Amit G. Singal and Purva Gopal have contributed equally to this manuscript and are co-senior authors for this manuscript.

StephenW

2015年6月，第60卷，第6期，第1841至1847年
日期：2015年1月14日
纤维化的超声无创和标记的精度识别肝硬化患者

    贾森·马丁，拉夫卡特里，Purva戈帕尔，艾米特G.葛



        内科，德州大学西南医学中心和帕克兰德健康医院系统，达拉斯，德克萨斯州，美国的1系
        放射科，UT西南医疗中心，达拉斯，德克萨斯州，美国的2部
        病理学，UT西南医疗中心，达拉斯，德克萨斯州，美国的3系
        4.司消化和肝病临床护理Dedman学者，得克萨斯大学西南，5959哈里海因斯大道​​，POB 1，套房420，达拉斯，德克萨斯州，75390-8887，美国大学


抽象
背景

准确识别患者使用纤维化无创肝硬化标志是食管静脉曲张和肝细胞癌监视计划非常有用。我们研究的目的是表征超声的准确性，AST对血小板比率指数（APRI），和FIB-4作为非侵入性标记物，以确定肝硬化的存在。
方法

我们进行的谁接受肝活检在大型城市安全网的机构2008年11月和2011年7月的敏感性，特异性，阳性预测值（PPV），阴性预测值之间的患者回顾性队列研究，并采用受试者工作特征总体精度计算每个非侵入性标记为肝硬化的检测曲线分析。
结果

在388例患者进行肝活检，其中93（24.0％）有肝硬化。 C-统计APRI和FIB-4预测肝硬化的存在为0.68（95％CI 0.63-0.74）和0.73（95％CI 0.68-0.78），分别为。 c-统计的结节出现在超声为0.78（95％CI 0.72-0.83）。一个缩小结节，肝出现的PPV为64.8％;然而，PPV是显著高于有肝硬化，出现在与无创肝纤维化指标也提示肝硬化（PPV 77.8％，P的子集，肝门静脉高压症（PPV 83.6％，P = 0.01）的迹象，以及<子集0.001）。
结论

血清和肝纤维化成像无创性标志物可能在单独使用时不够准确;然而，标记物的组合可以允许足够的精度，以系统地确定的肝硬化患者。

阿米特G.葛和Purva戈帕尔都同样促成了这篇稿子，并共同高级作者对这份手稿。