Tatsumi Chie, Kudo Masatoshi, Ueshima Kazuomi, Kitai Satoshi, Takahashi Shunsuke, Inoue Tatsuo, Minami Yasunori, Chung Hobyung, Maekawa Kiyoshi, Fujimoto Kenji, Akiko Tonomura, Takeshi Mitake
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan.
Intervirology. 2008;51 Suppl 1:27-33. doi: 10.1159/000122602. Epub 2008 Jun 10.
The aim of this study was to investigate the accuracy of noninvasive tests, e.g. serum fibrotic markers, transient elastography and real-time tissue elastography, in the diagnosis of hepatic fibrosis, and to determine whether they can replace liver biopsy.
119 patients with chronic liver disease were included in this study. Serum fibrotic markers including hyaluronic acid, type IV collagen, type IV collagen 7S domain and type III procollagen-N-peptide were measured. Aspartate aminotransferase (AST) and platelet counts were also measured to calculate the AST to platelet ratio index (APRI). Liver stiffness was measured using FibroScan and real-time tissue elastography.
The fibrotic stage, determined by histopathological diagnosis of a liver biopsy sample, did not correlate as well with serum fibrotic markers although it was useful to diagnose liver cirrhosis. However, the stage of hepatic fibrosis correlated well with liver stiffness measured by FibroScan. FibroScan was also a much better predictor of liver cirrhosis than APRI. Furthermore, the levels of liver strain measured by real-time tissue elastography correlated well with liver stiffness (p < 0.05).
Serum fibrotic markers and FibroScan are useful for distinguishing liver cirrhosis (F4) from chronic hepatitis (F1-F3). In addition, real-time tissue elastography is a novel and promising method to determine the stage of hepatic fibrosis.
本研究旨在探讨非侵入性检测方法，如血清纤维化标志物、瞬时弹性成像和实时组织弹性成像在肝纤维化诊断中的准确性，并确定它们是否能够取代肝活检。
本研究纳入了119例慢性肝病患者。检测血清纤维化标志物，包括透明质酸、IV型胶原、IV型胶原7S区和III型前胶原N端肽。还检测了天冬氨酸转氨酶（AST）和血小板计数，以计算AST与血小板比值指数（APRI）。使用FibroScan和实时组织弹性成像测量肝脏硬度。
尽管肝活检样本的组织病理学诊断对于诊断肝硬化有用，但纤维化阶段与血清纤维化标志物的相关性不佳。然而，肝纤维化阶段与通过FibroScan测量的肝脏硬度相关性良好。FibroScan在预测肝硬化方面也比APRI好得多。此外，通过实时组织弹性成像测量的肝脏应变水平与肝脏硬度相关性良好（p < 0.05）。
血清纤维化标志物和FibroScan有助于区分肝硬化（F4）与慢性肝炎（F1 - F3）。此外，实时组织弹性成像是确定肝纤维化阶段的一种新颖且有前景的方法。
