Department of Gastroenterology, St Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
J Clin Gastroenterol. 2010 Sep;44(8):575-82. doi: 10.1097/MCG.0b013e3181cb4216.
BACKGROUND/GOALS: Consensus is lacking whether cut-off values for different fibrosis stages using transient elastography (TE, FibroScan) are universally applicable to all liver diseases. We evaluated the performance of TE in predicting severe fibrosis (> or =F3) in alcoholic patients using cut-off values validated for chronic hepatitis C.
Patients admitted for alcohol withdrawal were prospectively evaluated by TE and biochemistry for aspartate aminotransferase to platelet ratio index (APRI) and Forns score calculations. If TE revealed severe fibrosis (> or =F3), hepatic venous pressure gradient measurements and transjugular liver biopsy were proposed results of which were correlated and compared with TE measurements or APRI and Forns scores.
Among 239 patients, 72 had liver TE scores > or =F3 and 23 declined liver biopsy leaving a final study population of 49 patients. Compared with biopsy, 32 patients were correctly classified by TE, whereas 16 patients differed by 2 fibrosis stages yielding a positive predictive value of 65% for liver fibrosis > or =F3 at TE. Specificity and sensitivity of TE improved beyond 75% and 70%, respectively, with modified cut-offs of 17 (F3) and 21.1 kPa (F4). Areas under the receiver operating characteristic curves were 0.766 and 0.864 for severe fibrosis (> or =F3) and cirrhosis, respectively. APRI and Forns scores performed less well than TE regarding sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic values. A significant correlation was found between hepatic venous pressure gradients and liver stiffness values at TE.
TE with modified cut-offs has the potential to predict advanced fibrosis and significant portal hypertension in alcoholic patients. APRI and Forns scores are of limited usefulness in alcoholics.
背景/目的：使用瞬时弹性成像（TE，FibroScan）对不同纤维化阶段的截断值是否普遍适用于所有肝病，目前尚无共识。我们评估了使用慢性丙型肝炎验证的截断值预测酒精性患者严重纤维化（≥F3）的 TE 的性能。
前瞻性地对因酒精戒断而入院的患者进行 TE 和生化检查，以计算天冬氨酸氨基转移酶与血小板比值指数（APRI）和福恩斯评分。如果 TE 显示严重纤维化（≥F3），则建议进行肝静脉压力梯度测量和经颈静脉肝活检，将这些结果与 TE 测量值或 APRI 和福恩斯评分进行相关和比较。
在 239 例患者中，有 72 例患者的肝脏 TE 评分≥F3，23 例患者拒绝肝活检，最终研究人群为 49 例患者。与活检相比，TE 正确分类了 32 例患者，而 16 例患者的纤维化分期相差 2 级，TE 对肝纤维化≥F3 的阳性预测值为 65%。TE 的特异性和敏感性分别提高到 75%和 70%以上，截断值分别为 17（F3）和 21.1kPa（F4）。严重纤维化（≥F3）和肝硬化的受试者工作特征曲线下面积分别为 0.766 和 0.864。APRI 和福恩斯评分在敏感性、特异性、阳性预测值、阴性预测值和受试者工作特征曲线下面积方面均不如 TE。TE 检测到的肝硬度值与肝静脉压力梯度之间存在显著相关性。
经修正截断值的 TE 有可能预测酒精性患者的晚期纤维化和显著门静脉高压。APRI 和福恩斯评分在酒精性患者中用处有限。
