Hospices Civils de Lyon, Hôpital Hôtel-Dieu, Service d'Hépatogastroentérologie, Lyon, France.
J Viral Hepat. 2011 Jan;18(1):61-9. doi: 10.1111/j.1365-2893.2010.01275.x.
Transient elastography (TE) is a noninvasive technique to evaluate liver fibrosis. We compared the performance of TE with liver biopsy (LB) in patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection. Patients prospectively underwent TE and LB. The diagnosis accuracy of TE was calculated using receiver operating characteristic (ROC) curves for different stages of fibrosis, and optimal cut-off values were defined. A sequential algorithm combining TE with biochemical score (Fibrotest) is proposed. Fifty-seven patients had both TE and LB (median time: 3 days) and two with proven cirrhosis, only TE. Forty-six (78%) were under antiretroviral therapy with anti-HBV drugs in 98%, and 19 (32%) had elevated alanine aminotransferase (ALT). A significant correlation was observed between liver stiffness measurement (LSM) and METAVIR fibrosis stages (P < 0.0001). Patients with elevated ALT tended to have higher LSM than those with normal ALT. The areas under the ROC curves were 0.85 for significant fibrosis (≥ F2), 0.92 for advanced fibrosis (≥ F3) and 0.96 for cirrhosis. Using a cut-off of 5.9 kPa for F ≥ 2 and 7.6 kPa for F ≥ 3, the diagnosis accuracy was 83% and 86%, respectively. With an algorithm combining TE and Fibrotest, 97% of patients were well classified for significant fibrosis. Using this algorithm, the need for LB can be reduced by 67%. In HIV/HBV-coinfected patients, most of them with normal ALT under antiretroviral treatment including HBV active drugs, TE was proficient in discriminating moderate to severe fibrosis from minimal liver disease.
瞬时弹性成像（TE）是一种评估肝纤维化的非侵入性技术。我们比较了 TE 和肝活检（LB）在人类免疫缺陷病毒（HIV）和乙型肝炎病毒（HBV）合并感染患者中的表现。患者前瞻性地接受了 TE 和 LB 检查。使用受试者工作特征（ROC）曲线计算 TE 对不同纤维化阶段的诊断准确性，并定义了最佳截断值。提出了一种结合 TE 和生化评分（Fibrotest）的序贯算法。57 例患者同时进行了 TE 和 LB（中位时间：3 天），2 例有明确肝硬化，仅进行了 TE。46 例（78%）正在接受抗逆转录病毒治疗和抗 HBV 药物治疗，98%患者的乙型肝炎病毒载量处于检测下限，19 例（32%）丙氨酸氨基转移酶（ALT）升高。肝脏硬度测量（LSM）与 METAVIR 纤维化分期之间存在显著相关性（P < 0.0001）。ALT 升高的患者 LSM 高于 ALT 正常的患者。ROC 曲线下面积为：显著纤维化（≥ F2）为 0.85，进展性纤维化（≥ F3）为 0.92，肝硬化为 0.96。使用 5.9 kPa 作为 F ≥ 2 的截断值，7.6 kPa 作为 F ≥ 3 的截断值，诊断准确性分别为 83%和 86%。使用结合 TE 和 Fibrotest 的算法，97%的患者可以很好地对显著纤维化进行分类。使用该算法，可以减少 67%的 LB 需求。在 HIV/HBV 合并感染患者中，大多数患者在接受包括 HBV 活性药物在内的抗逆转录病毒治疗时 ALT 正常，TE 能够很好地区分中重度纤维化与轻度肝脏疾病。
