Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
Addiction. 2011 May;106(5):970-6. doi: 10.1111/j.1360-0443.2010.03246.x. Epub 2010 Dec 23.
Transient elastography (TE) is a non-invasive sensitive tool for diagnosing cirrhosis in hospital-based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users.
Cross-sectional study.
All treatment centres in the county of Funen, Denmark.
Drug users attending treatment centres during the presence of the study team.
Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM ≥ 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM ≥ 12 kPa were recommended a liver biopsy.
Among 175 drug users negative for hepatitis C, 13% had LSM = 8-11.9 kPa and 4% had LSM ≥ 12 kPa; elevated LSM was associated with a body mass index (BMI) > 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8-11.9 kPa and 21.1% had LSM ≥ 12 kPa (P < 0.001). Repeat LSM at liver biopsy performed a median 3 months after screening showed a significant decrease (<12 kPa) among 30% (six of 20), and this was independent of alcohol consumption, BMI, age and gender. In 29 patients where liver biopsy was performed a LSM ≥ 16 kPa predicted cirrhosis with 88.9% sensitivity and 90% specificity.
Transient elastography is a feasible screening tool for cirrhosis among drug users. Transient elastography identifies severe liver fibrosis in a significant proportion of drug users with hepatitis C infections but management should not be based on a single elevated liver stiffness measurement.
瞬时弹性成像（TE）是一种用于诊断医院队列中肝硬化的非侵入性敏感工具。本研究旨在评估 TE 作为一种筛选工具，用于检测吸毒者中的肝硬化。
横断面研究。
丹麦菲英郡所有的治疗中心。
在研究团队在场期间，参加治疗中心的吸毒者。
使用 Fibroscan 设备进行瞬时弹性成像的肝硬度测量（LSM）；血液检测病毒肝炎、HIV 感染和透明质酸（HA）水平；以及常规肝功能检查。LSM≥8kPa 的个体被转介到医院进行治疗评估。LSM≥12kPa 的个体建议进行肝活检。
在 175 名丙型肝炎阴性的吸毒者中，13%的人 LSM=8-11.9kPa，4%的人 LSM≥12kPa；升高的 LSM 与体重指数（BMI）>30 相关。在 128 名患有慢性丙型肝炎的吸毒者中，19.5%的人 LSM=8-11.9kPa，21.1%的人 LSM≥12kPa（P<0.001）。在筛查后中位 3 个月进行的肝活检重复 LSM 显示，20 例中有 6 例（30%）显著下降（<12kPa），这与酒精摄入、BMI、年龄和性别无关。在 29 例进行肝活检的患者中，LSM≥16kPa 预测肝硬化的敏感性为 88.9%，特异性为 90%。
瞬时弹性成像可作为吸毒者肝硬化的一种可行筛查工具。瞬时弹性成像在丙型肝炎感染的吸毒者中识别出显著比例的严重肝纤维化，但管理不应基于单次升高的肝硬度测量值。
