Kim Seung Up, Han Kwang-Hyub, Park Jun Yong, Ahn Sang Hoon, Chung Moon Jae, Chon Chae Yoon, Choi Eun Hee, Kim Do Young
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Liver Int. 2009 Jul;29(6):810-5. doi: 10.1111/j.1478-3231.2008.01894.x. Epub 2008 Oct 24.
Liver stiffness measurement (LSM) using FibroScan is accepted as a highly reproducible and accurate technique for assessment of liver fibrosis. However, several studies have indicated that the LSM value can be significantly influenced by major changes in aminotransferases in patients with chronic viral hepatitis and LSM is unreliable for diagnosing underlying liver cirrhosis in patients with acute liver damage. We aimed to determine biochemical factors influencing the LSM value in patients with acute hepatitis.
From July to December 2007, a total of 60 patients with acute hepatitis of varying aetiologies were recruited prospectively. LSM and biochemical tests were performed at diagnosis and recovery from acute hepatitis.
The mean age of the patients (38 men and 22 women) was 40.7+/-15.4 years. The aetiology of acute hepatitis included hepatitis A virus in 31 patients, drug induced in 19 and hepatitis B virus in 10. The mean LSM value was 19.6 kPa at diagnosis and 15.9 kPa at recovery. Correlation analysis showed that the LSM value at diagnosis was significantly associated with platelet count (P=0.023), alanine aminotransferase (P=0.045), albumin (P<0.001), total bilirubin (P=0.004) and prothrombin time (P=0.005). However, additional correlation analysis between the changes in LSM value and biochemical factors from diagnosis to recovery showed that the change in total bilirubin was found to be the only factor associated with the change in the LSM value (P<0.001).
Our data suggest that the LSM value might be influenced by serum total bilirubin in patients with acute hepatitis without pre-existing underlying chronic liver disease.
使用FibroScan进行肝脏硬度测量（LSM）被认为是评估肝纤维化的一种高度可重复且准确的技术。然而，多项研究表明，慢性病毒性肝炎患者转氨酶的重大变化可显著影响LSM值，且LSM在诊断急性肝损伤患者潜在肝硬化方面并不可靠。我们旨在确定影响急性肝炎患者LSM值的生化因素。
2007年7月至12月，前瞻性招募了60例不同病因的急性肝炎患者。在诊断急性肝炎时及恢复时进行LSM和生化检查。
患者（38例男性和22例女性）的平均年龄为40.7±15.4岁。急性肝炎的病因包括31例甲型肝炎病毒感染、19例药物性肝炎和10例乙型肝炎病毒感染。诊断时的平均LSM值为19.6 kPa，恢复时为15.9 kPa。相关性分析显示，诊断时的LSM值与血小板计数（P = 0.023）、丙氨酸转氨酶（P = 0.045）、白蛋白（P < 0.001）、总胆红素（P = 0.004）和凝血酶原时间（P = 0.005）显著相关。然而，LSM值从诊断到恢复的变化与生化因素之间的进一步相关性分析显示，总胆红素的变化是与LSM值变化相关的唯一因素（P < 0.001）。
我们的数据表明，在无预先存在的潜在慢性肝病的急性肝炎患者中，LSM值可能受血清总胆红素影响。
