Marcellin Patrick, Ziol Marianne, Bedossa Pierre, Douvin Catherine, Poupon Raoul, de Lédinghen Victor, Beaugrand Michel
Service d'Hépatologie and INSERM U 773, Hôpital Beaujon, AP-HP, University of Paris, Clichy, France.
Liver Int. 2009 Feb;29(2):242-7. doi: 10.1111/j.1478-3231.2008.01802.x. Epub 2008 Jul 9.
The need for new non-invasive tools to assess liver fibrosis in chronic liver diseases has been largely advocated. Liver stiffness measurement (LSM) using transient elastography (FibroScan), Echosens) has been shown to be correlated to liver fibrosis in various chronic liver diseases. This study aims to assess its diagnosis accuracy in patients with chronic hepatitis B.
We prospectively enrolled 202 patients with chronic hepatitis B in a multicentre study. Patients underwent liver biopsy (LB) and LSM. METAVIR and Ishak liver fibrosis stages were assessed by two pathologists.
LSM or LB was considered unreliable in 29 patients. Statistical analysis was conducted in 173 patients. LSM was significantly (P<0.001) correlated with METAVIR (r=0.65) and Ishak fibrosis stage (0.65). The area under receiver-operating characteristic curves were 0.81 (95% confidence intervals, 0.73-0.86) for F>/=2, 0.93 (0.88-0.96) for F>/=3 and 0.93 (0.82-0.98) for F=4. Optimal LSM cut-off values were 7.2 and 11.0 kPa for F>/=2 and F=4, respectively, by maximizing the sum D of sensitivity and specificity, and 7.2 and 18.2 kPa by maximizing the diagnosis accuracy.
In conclusion, LSM appears to be reliable for detection of significant fibrosis or cirrhosis in HBV patients and cut-off values are only slightly different from those observed in HCV patients.
人们大力提倡需要新的非侵入性工具来评估慢性肝病中的肝纤维化。使用瞬时弹性成像（FibroScan，Echosens）进行肝脏硬度测量（LSM）已被证明与各种慢性肝病中的肝纤维化相关。本研究旨在评估其在慢性乙型肝炎患者中的诊断准确性。
我们在一项多中心研究中前瞻性纳入了202例慢性乙型肝炎患者。患者接受了肝活检（LB）和LSM。两名病理学家评估了METAVIR和Ishak肝纤维化分期。
29例患者的LSM或LB被认为不可靠。对173例患者进行了统计分析。LSM与METAVIR（r = 0.65）和Ishak纤维化分期（0.65）显著相关（P < 0.001）。F≥2时，受试者操作特征曲线下面积为0.81（95%置信区间，0.73 - 0.86）；F≥3时为0.93（0.88 - 0.96）；F = 4时为0.93（0.82 - 0.98）。通过最大化灵敏度和特异性之和，F≥2和F = 4时的最佳LSM临界值分别为7.2和11.0 kPa；通过最大化诊断准确性，临界值分别为7.2和18.2 kPa。
总之，LSM似乎对于检测HBV患者的显著纤维化或肝硬化是可靠的，并且临界值与HCV患者中观察到的临界值仅略有不同。
