瞬时弹性成像技术用于检测非酒精性脂肪性肝病和慢性病毒性肝炎纤维化的可靠性。
Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis.
机构信息
San Giovanni Battista Hospital, Gastroenterology, C. Bramante 88 10128, Italy.
出版信息
J Hepatol. 2011 Jan;54(1):64-71. doi: 10.1016/j.jhep.2010.06.022. Epub 2010 Aug 21.
BACKGROUND & AIMS: Transient elastography (TE) is validated in chronic hepatitis C (CHC) to evaluate hepatic fibrosis; however, limited data are available in chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD). This prospective study is aimed to assess the accuracy and the efficacy of TE for the detection of fibrosis in patients with chronic liver disease of different etiology and to evaluate the effect of steatosis on the liver stiffness measurement (LSM).
METHODS
TE was performed in 219 consecutive patients with chronic liver disease (35% CHC, 32% CHB, and 33% NAFLD) within 6 months of the liver biopsy.
RESULTS
LSM was related to the fibrosis stage in each group (CHC: p = 0.596, p < 0.001; CHB: p = 0.418, p < 0.001; NAFLD: p = 0.573, p < 0.001), but the correlation was less strong in CHB and NAFLD than in CHC patients. In CHB patients with histological cirrhosis (F4), the median stiffness value was almost two times lower than in patients with severe fibrosis (F3). In NAFLD patients with advanced fibrosis (F3) and severe steatosis (> 33%), the LSM values were lower than expected and were similar to those of patients with initial fibrosis (F1) and fat < 33%. TE underestimated the stage of fibrosis in 75% of patients with F3 and steatosis > 33%. At multiple logistic regression analysis, in CHC and CHB patients, LSM was the only predictive variable of severe fibrosis/cirrhosis (OR = 1.42, p = 0.003 and OR = 1.354, p = 0.003, respectively), while in NAFLD subjects BMI and AST (OR = 1.433, p = 0.002 and OR = 1.053, p = 0.020, respectively) but not LSM were independently related with advanced fibrosis and cirrhosis.
CONCLUSIONS
This study confirms that TE can be considered a valid support to detect fibrosis in chronic liver disease related to HCV but it should be interpreted cautiously in CHB and NAFLD patients, where host or disease-related factors may modify its accuracy.
背景与目的
瞬时弹性成像（TE）已在慢性丙型肝炎（CHC）中得到验证，可用于评估肝纤维化；然而，在慢性乙型肝炎（CHB）和非酒精性脂肪性肝病（NAFLD）中，相关数据有限。本前瞻性研究旨在评估 TE 检测不同病因慢性肝病患者纤维化的准确性和有效性，并评估脂肪变性对肝硬度测量（LSM）的影响。
方法
在肝活检后 6 个月内，对 219 例连续慢性肝病患者（35%CHC、32%CHB 和 33%NAFLD）进行 TE 检查。
结果
LSM 与各组的纤维化分期相关（CHC：p = 0.596，p < 0.001；CHB：p = 0.418，p < 0.001；NAFLD：p = 0.573，p < 0.001），但在 CHB 和 NAFLD 患者中，相关性不如 CHC 患者强。在乙型肝炎病毒相关性肝硬化（F4）患者中，中位数硬度值几乎是严重纤维化（F3）患者的两倍。在 NAFLD 患者中，纤维化程度为 F3 且严重脂肪变性（>33%）的患者，LSM 值低于预期，与纤维化程度为 F1 且脂肪变性<33%的患者相似。TE 在 75%的 F3 且脂肪变性>33%的患者中低估了纤维化分期。在多因素逻辑回归分析中，在 CHC 和 CHB 患者中，LSM 是严重纤维化/肝硬化的唯一预测变量（OR=1.42，p=0.003 和 OR=1.354，p=0.003），而在 NAFLD 患者中，BMI 和 AST（OR=1.433，p=0.002 和 OR=1.053，p=0.020），但不是 LSM，与晚期纤维化和肝硬化独立相关。
结论
本研究证实，TE 可被视为检测 HCV 相关慢性肝病纤维化的有效辅助手段，但在 CHB 和 NAFLD 患者中应谨慎解释，因为宿主或疾病相关因素可能会改变其准确性。
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