Unité d' Hépatologie, Hopital Avicenne, France.
Gut. 2011 Jul;60(7):977-84. doi: 10.1136/gut.2010.221382. Epub 2010 Nov 10.
Liver stiffness measurement (LSM) has been used to measure fibrosis in patients with various types of chronic liver diseases. However, its usefulness as a screening procedure in apparently healthy people had not been evaluated to date.
1358 subjects >45 years old from a general population attending for a medical check-up were consecutively enrolled in the study. All subjects were submitted to medical examination and laboratory tests in addition to LSM, performed on the same day by a single operator. Subjects with LSM values >8 kPa were referred to a liver unit for further investigations.
168 subjects were not considered for analysis due to missing data (n=23), LSM failure (n=51) or unreliable LSM values (n=94). Among the 1190 remaining subjects, 89 (7.5%) had LSM >8 kPa including nine patients with LSM >13 kPa. Despite the fact that normal liver tests were observed in 43% of them (38 out of 89), a specific cause of chronic liver disease was found in all cases. Non-alcoholic fatty liver disease (NAFLD) was the likely cause of chronic liver disease in 52 patients, alcoholic liver disease (ALD) in 20, and both causes were associated in seven additional patients. Hepatitis C virus and hepatitis B virus chronic hepatitis was documented in five and four cases, respectively, and primary biliary cirrhosis in one. Liver biopsy was obtained for 27 patients, including the nine patients with LSM >13 kPa, who were diagnosed with liver cirrhosis due to ALD (n=5), chronic hepatitis C (n=3) or chronic hepatitis B (n=1). The 18 remaining biopsies showed liver fibrosis in all cases except one (isolated steatosis), with ALD and NAFLD being present in six and eight cases, respectively.
LSM proved to be a useful and specific procedure to screen for cirrhosis in the general population and to detect undiagnosed chronic liver disease in apparently healthy subjects.
肝硬度测量（LSM）已被用于测量各种类型慢性肝病患者的纤维化程度。然而，迄今为止，尚未评估其在貌似健康人群中的筛查作用。
从参加体检的一般人群中连续纳入 1358 名年龄>45 岁的受试者。所有受试者均接受体格检查和实验室检查，以及由同一位操作人员于同一天进行的 LSM 检查。LSM 值>8kPa 的受试者被转介到肝脏科进行进一步检查。
由于数据缺失（n=23）、LSM 失败（n=51）或不可靠的 LSM 值（n=94），168 名受试者未被纳入分析。在其余 1190 名受试者中，89 名（7.5%）的 LSM>8kPa，其中 9 名患者的 LSM>13kPa。尽管他们中有 43%（38 名）的肝功能检查正常，但在所有病例中均发现了慢性肝病的特定病因。52 名患者的慢性肝病病因可能是非酒精性脂肪性肝病（NAFLD），20 名患者的病因可能是酒精性肝病（ALD），另有 7 名患者的病因同时与两者相关。丙型肝炎病毒和乙型肝炎病毒慢性肝炎分别在 5 例和 4 例中得到证实，1 例为原发性胆汁性肝硬化。对 27 名患者进行了肝活检，包括 9 名 LSM>13kPa 的患者，这些患者因 ALD（n=5）、丙型肝炎（n=3）或乙型肝炎（n=1）被诊断为肝硬化。其余 18 例活检均显示所有病例存在肝纤维化，除 1 例外均无孤立性脂肪变性，其中 ALD 和 NAFLD 分别存在于 6 例和 8 例。
LSM 是一种有用且特异的方法，可用于筛查一般人群中的肝硬化，并可在貌似健康的受试者中发现未诊断的慢性肝病。
