慢性丙型肝炎患者肝硬化和食管静脉曲张在常规临床实践中的早期检测：瞬时弹性成像（FibroScan）与标准实验室检查及非侵入性评分的比较
Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores.
作者信息
Castéra Laurent, Le Bail Brigitte, Roudot-Thoraval Françoise, Bernard Pierre-Henri, Foucher Juliette, Merrouche Wassil, Couzigou Patrice, de Lédinghen Victor
机构信息
Service d'Hépato-Gastroentérologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire (CHU) de Bordeaux, Pessac, France.
出版信息
J Hepatol. 2009 Jan;50(1):59-68. doi: 10.1016/j.jhep.2008.08.018. Epub 2008 Oct 26.
BACKGROUND/AIMS: To assess prospectively the accuracy of transient elastography (TE, FibroScan) for the detection of cirrhosis and oesophageal varices (OV) in chronic hepatitis C (CHC), as compared with currently available non-invasive methods (AST/ALT ratio (AAR), APRI, prothrombin index (PI), platelet count (PC), FibroTest (FT) and Lok index).
METHODS
All tests were performed the day of liver biopsy (LB), taken as reference, in 298 consecutive CHC patients (cirrhosis: 70; Child-Pugh A: 70; OV: 25).
RESULTS
TE had the best diagnostic accuracy for detection of cirrhosis (AUROCs: TE 0.96 vs. FT 0.82, Lok and APRI 0.80, PC 0.79, PI 0.73, AAR 0.61, respectively; p < 0.0001). Overall, the percentage of saved LB was: TE (cut-off: 12.5 kPa) 90%, PC 82%, FT 79%, PI 77%, AAR 76%, APRI 70%, and Lok 45%, respectively. At a cut-off of 21.5 kPa, TE predicted the presence of OV with 76% sensitivity and 78% specificity and correctly classified 73% of patients vs. AAR 81%, Lok 77%, FT, PI 70%, PC 69%, and APRI 66%, respectively.
CONCLUSIONS
TE is currently the most accurate non-invasive method for early detection of cirrhosis in CHC (cut-off: 12.5 kPa), as compared with other available methods, but cannot replace endoscopy for OV screening.
背景/目的：与目前可用的非侵入性方法（AST/ALT比值（AAR）、APRI、凝血酶原指数（PI）、血小板计数（PC）、FibroTest（FT）和Lok指数）相比，前瞻性评估瞬时弹性成像（TE，FibroScan）检测慢性丙型肝炎（CHC）患者肝硬化和食管静脉曲张（OV）的准确性。
方法
对298例连续的CHC患者（肝硬化：70例；Child-Pugh A级：70例；OV：25例）在肝活检（LB）当天进行所有检测，以肝活检结果作为参考。
结果
TE在检测肝硬化方面具有最佳诊断准确性（受试者工作特征曲线下面积：TE为0.96，FT为0.82，Lok和APRI为0.80，PC为0.79，PI为0.73，AAR为0.61；p<0.0001）。总体而言，避免肝活检的比例分别为：TE（临界值：12.5 kPa）90%，PC 82%，FT 79%，PI 77%，AAR 76%，APRI 70%，Lok 45%。在临界值为21.5 kPa时，TE预测OV存在的敏感性为76%，特异性为78%，正确分类患者的比例为73%，而AAR、Lok、FT、PI、PC和APRI分别为81%、77%、70%、70%、69%和66%。
结论
与其他可用方法相比，TE目前是CHC患者早期检测肝硬化最准确的非侵入性方法（临界值：12.5 kPa），但不能替代内镜检查进行OV筛查。
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