Wang Jing-Houng, Changchien Chi-Sin, Hung Chao-Hung, Eng Hock-Liew, Tung Wei-Chih, Kee Kwong-Ming, Chen Chien-Hung, Hu Tsung-Hui, Lee Chuan-Mo, Lu Sheng-Nan
Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao Sung, Kaohsiung, Taiwan.
J Gastroenterol. 2009;44(5):439-46. doi: 10.1007/s00535-009-0017-y. Epub 2009 Mar 25.
The aim of this study was to assess the diagnostic performances of liver stiffness measurement (LSM), ultrasonography (US) and their combined use in predicting the extent of hepatic fibrosis.
Consecutive patients with chronic hepatitis B (HBV) or hepatitis C virus (HCV) infections, with indications for liver biopsy, were prospectively enrolled. LSM was performed on the same day as biopsy. US scores, including assessment of liver surface, liver parenchyma, intrahepatic vessels and spleen index, were used to assess the degree of hepatic fibrosis. The pathological findings were used as a reference standard and diagnostic accuracy was assessed and compared.
Three-hundred and twenty patients, including 199 men and 121 women, with a mean age of 50.8 years, were analyzed. There were 214 (66.9%) HCV patients, 88 (27.5%) HBV patients and 18 (5.6%) patients with both HCV and HBV. LSM correlated significantly with the hepatic fibrosis (F) scores, necro-inflammatory activity and US scores in multivariate analysis. The diagnostic accuracy of LSM is significantly superior to US, and equal to combined LSM with US, in the prediction of all HCV-related fibrosis scores. The cut-off value of LSM is 6 kPa for diagnosing F > =1, with a positive predictive value of 91%. Also, the cut-off value is 12 kPa for the prediction of cirrhosis, with a negative predictive value of 94%.
LSM is useful for predicting hepatic fibrosis and excluding cirrhosis. A combination of LSM and US does not improve the accuracy in assessing hepatic fibrosis.
本研究旨在评估肝脏硬度测量（LSM）、超声检查（US）及其联合应用在预测肝纤维化程度方面的诊断性能。
前瞻性纳入连续的慢性乙型肝炎（HBV）或丙型肝炎病毒（HCV）感染且有肝活检指征的患者。LSM在活检当天进行。US评分，包括肝脏表面、肝实质、肝内血管和脾脏指数的评估，用于评估肝纤维化程度。以病理结果作为参考标准，评估并比较诊断准确性。
分析了320例患者，包括199例男性和121例女性，平均年龄50.8岁。其中214例（66.9%）为HCV患者，88例（27.5%）为HBV患者，18例（5.6%）为HCV和HBV合并感染患者。多因素分析显示，LSM与肝纤维化（F）评分、坏死性炎症活动及US评分显著相关。在预测所有HCV相关纤维化评分方面，LSM的诊断准确性显著优于US，且与LSM联合US相当。LSM诊断F≥1的临界值为6 kPa，阳性预测值为91%。此外，预测肝硬化的临界值为12 kPa，阴性预测值为94%。
LSM有助于预测肝纤维化并排除肝硬化。LSM与US联合应用并不能提高评估肝纤维化的准确性。
