Wong Grace Lai-Hung, Wong Vincent Wai-Sun, Choi Paul Cheung-Lung, Chan Anthony Wing-Hung, Chum Richard Hoi-Leong, Chan Henry Kai-Wing, Lau Kenneth Ka-Ki, Chim Angel Mei-Ling, Yiu Karen Ka-Lam, Chan Francis Ka-Leung, Sung Joseph Jao-Yao, Chan Henry Lik-Yuen
Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.
Clin Gastroenterol Hepatol. 2008 Sep;6(9):1027-35. doi: 10.1016/j.cgh.2008.02.038. Epub 2008 May 5.
BACKGROUND & AIMS: Liver stiffness measurement (LSM) with transient elastography (Fibroscan) can accurately diagnose advanced liver fibrosis, but its performance in early liver fibrosis is less satisfactory. We aimed to study the diagnostic performance of LSM for histologic bridging fibrosis and cirrhosis in various chronic liver diseases and to investigate the effects of liver fibrosis distribution on LSM.
We prospectively studied consecutive patients with chronic liver diseases undergoing liver biopsy and transient elastography examinations. Morphometric analysis was performed to evaluate the distribution of liver fibrosis.
One hundred thirty-three patients (50% chronic hepatitis B, 14% chronic hepatitis C, and 24% nonalcoholic fatty liver disease) were studied. Morphometric analysis revealed a higher correlation between LSM and pericellular fibrosis (r = 0.43) than periportal (r = 0.21) or perivenular fibrosis (r = 0.25). Area under receiver operating characteristic curve (ROC) of LSM for bridging fibrosis was 0.87 (95% confidence interval, 0.81-0.93) and for cirrhosis was 0.89 (95% confidence interval, 0.83-0.94). Higher LSM was associated with higher serum ALT level. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM. The area under ROC curve of LSM for cirrhosis was lower among patients who had ALT above the upper limit of normal (0.86) as compared with that of patients with normal ALT levels (0.93, P = .03).
Transient elastography can diagnose severe fibrosis because of its good correlation with pericellular fibrosis. Transient elastography might overestimate liver fibrosis when ALT is elevated.
使用瞬时弹性成像（Fibroscan）进行肝脏硬度测量（LSM）可准确诊断晚期肝纤维化，但其在早期肝纤维化中的表现不太令人满意。我们旨在研究LSM对各种慢性肝病中组织学桥接纤维化和肝硬化的诊断性能，并探讨肝纤维化分布对LSM的影响。
我们对连续接受肝活检和瞬时弹性成像检查的慢性肝病患者进行了前瞻性研究。进行形态计量分析以评估肝纤维化的分布。
共研究了133例患者（50%为慢性乙型肝炎，14%为慢性丙型肝炎，24%为非酒精性脂肪性肝病）。形态计量分析显示，LSM与细胞周围纤维化（r = 0.43）的相关性高于门周纤维化（r = 0.21）或中央静脉周围纤维化（r = 0.25）。LSM诊断桥接纤维化的受试者工作特征曲线（ROC）下面积为0.87（95%置信区间，0.81 - 0.93），诊断肝硬化的ROC下面积为0.89（95%置信区间，0.83 - 0.94）。较高的LSM与较高的血清ALT水平相关。纤维化分期相同但ALT水平较高的患者往往具有较高的LSM。与ALT水平正常的患者相比，ALT高于正常上限的患者中LSM诊断肝硬化的ROC曲线下面积较低（0.86）（0.93，P = 0.03）。
瞬时弹性成像因其与细胞周围纤维化的良好相关性可诊断严重纤维化。当ALT升高时，瞬时弹性成像可能高估肝纤维化。
