Fung James, Lai Ching-Lung, Fong Daniel Yee-Tak, Yuen John Chi-Hang, Wong Danny Ka-Ho, Yuen Man-Fung
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, Hong Kong.
Liver Int. 2008 Dec;28(10):1408-16. doi: 10.1111/j.1478-3231.2008.01784.x. Epub 2008 May 14.
Abstract Aim: To correlate liver stiffness with demographical factors and routine liver biochemistry and to assess the predictive value of these as potential markers of fibrosis.
Transient elastography was performed in 1268 chronic hepatitis B (CHB) patients. According to a previous validated study for CHB, liver stiffness of >8.1 and >10.3 kPa were used as cut-off values for defining severe fibrosis and cirrhosis respectively.
Liver stiffness correlated positively with bilirubin, alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), globulin, alpha-fetoprotein (AFP) and HBV DNA levels and negatively with albumin and platelet levels (P<0.05 for all correlations). From 13 parameters (age, sex, platelet, AST, ALT, GGT, AFP, albumin, globulin, bilirubin, ALP, HBV DNA and hepatitis B e-antigen), four best parameters (AST, platelet, GGT and AFP) were used to derive a liver stiffness model. Using log (index)=1.44+0.1490(GGT)+0.3308 log (AST)-0.5846 log (platelets)+0.1148 log (AFP+1) to predict both severe fibrosis and cirrhosis had area under the receiver operating characteristics curve of 0.85.
Routine liver biochemistry correlated well with liver stiffness in Asian CHB patients. A model using simple serum markers can predict liver stiffness, and further studies are required to validate the usefulness of these simple tests as non-invasive markers of fibrosis in CHB.
摘要 目的：将肝脏硬度与人口统计学因素及常规肝脏生化指标进行关联，并评估这些指标作为纤维化潜在标志物的预测价值。
对1268例慢性乙型肝炎（CHB）患者进行瞬时弹性成像检查。根据先前一项针对CHB的有效研究，将肝脏硬度>8.1 kPa和>10.3 kPa分别用作定义严重纤维化和肝硬化的临界值。
肝脏硬度与胆红素、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、球蛋白、甲胎蛋白（AFP）和HBV DNA水平呈正相关，与白蛋白和血小板水平呈负相关（所有相关性P<0.05）。从13项参数（年龄、性别、血小板、AST、ALT、GGT、AFP、白蛋白、球蛋白、胆红素、ALP、HBV DNA和乙肝e抗原）中，选取四个最佳参数（AST、血小板、GGT和AFP）来建立肝脏硬度模型。使用log（指数）=1.44 + 0.1490（GGT）+ 0.3308 log（AST）- 0.5846 log（血小板）+ 0.1148 log（AFP + 1）来预测严重纤维化和肝硬化，受试者工作特征曲线下面积为0.85。
在亚洲CHB患者中，常规肝脏生化指标与肝脏硬度密切相关。使用简单血清标志物的模型可预测肝脏硬度，需要进一步研究来验证这些简单检测作为CHB纤维化非侵入性标志物的实用性。
