对慢性丙肝的临床不显著性肝硬化的无创诊断测试对比

　　背景：肝活检是测定慢性丙肝患者肝硬化的金标准，但是价格昂贵，同时也存在并发症的可能。现在已经有了可以替代的无创方法，但是他的可用性并不确定。

　　目的：对比5种无创诊断检测肝硬化的准确性。

　　方法：我们观察了228个进行治疗的丙肝患者的活检，13.2%的人经组织学检测为肝硬化。五个替代的指数是API、硬化判别分数、APRI、波尔指数和AAR。

　　结果：这些分数特性都是好的（87-100%），但是他们的灵敏度却并非如此（17-67%）。阳性相似比一般是好的，但是阴性相似比就次优了。这些指数结合能独立描述肝硬化，只会轻微的改变诊断的准确性。使用排除或诊断肝硬化的双重分离点，肝硬化确定指数定义为21%，没有误诊和APRI定义为85%，有9%的误诊率。

　　结论：五个指数单独或者联合使用，显示出灵敏度的差异和检测肝硬化的特性。双重分离点能使得硬化确定指数和APRI，更有效地降低肝活检患者数目。

　　原文：

　　Comparison of Simple Tests for the Non-invasive Diagnosis of Clinically Silent Cirrhosis in Chronic Hepatitis C

　　Background: Biopsy is the gold standard for assessing cirrhosis in patients with chronic hepatitis C virus infection, but it is expensive and at risk of complications.

　　Alternative non-invasive methods have been developed but their usefulness remains uncertain.

　　Aim: To compare the accuracy of five non-invasive scores in detecting cirrhosis.

　　Methods: We reviewed the charts and liver biopsies of 228 consecutive, treatment-naïve, hepatitis C virus-positive patients, 13.2% of whom with histological diagnosis of cirrhosis. The five alternative scores were age-platelet index, cirrhosis discriminant score, aspartate transaminases to platelet ratio index, Pohl's index, and aspartate transaminases/alanine transaminases ratio.

　　Results: The specificities of the scores were good (87-100%), but not so their sensitivities (17-67%). Accordingly positive likelihood ratios were generally good but negative likelihood ratios were suboptimal.Combinations of the scores independently related to cirrhosis only slightly change this diagnostic accuracy. Using double cut-offs to exclude/diagnoses cirrhosis, cirrhosis discriminant score classified 21% of patients without misdiagnoses and aspartate transaminases to platelet ratio index classified 85% of case with 9% of misdiagnoses.

　　Conclusions: The five scores showed variable sensitivities and specificities in detecting liver cirrhosis, both individually and in combination. The use of double cut-off points may make the cirrhosis discriminant score and aspartate transaminases to platelet ratio index useful to reduce the number of patients submitted to liver biopsy.