Department of Surgical and Gastroenterological Sciences, University of Padova, Padua, Italy.
Dig Liver Dis. 2011 Nov;43(11):887-92. doi: 10.1016/j.dld.2011.06.011. Epub 2011 Jul 23.
The performance of transient elastography in primary biliary cirrhosis has yet to be fully established.
To assess: (1) the performance of transient elastography in identifying significant fibrosis in primary biliary cirrhosis by comparison with surrogate markers (AST platelet ratio index (APRI), FIB-4, Fibroindex, Forns, aspartate aminotransferase/alanine aminotransferase ratio); (2) the correlation between liver stiffness and Mayo score prognostic index.
One hundred and twenty patients with primary biliary cirrhosis were consecutively enrolled. The performance of each marker and of liver stiffness was compared with histological staging and METAVIR at time of liver biopsy.
The area under receiver operating characteristic (ROC) of liver stiffness were 0.87, 0.88, 0.99 for histological stage ≥II, ≥III and =IV and 0.89, 0.92, 0.99 for METAVIR ≥2, ≥3 and =4. Transient elastography alone proved better able in identifying any grade of fibrosis or cirrhosis than noninvasive markers. Combining each surrogate marker with transient elastography did not improve the area under ROC. Transient elastography correlated positively with the Mayo score (P<0.001). Logistic regression analysis showed that transient elastography was associated with an advanced fibrosis (P<0.001).
Transient elastography proved a simple, reliable and useful method for assessing liver fibrosis in primary biliary cirrhosis, whereas noninvasive surrogate markers proved unsatisfactory in predicting significant fibrosis.
瞬时弹性成像在原发性胆汁性肝硬化中的表现尚未完全确定。
评估：（1）通过与替代标志物（天冬氨酸转氨酶/丙氨酸转氨酶比值、AST 血小板比值指数（APRI）、FIB-4、Fibroindex、Forns）相比，瞬时弹性成像在识别原发性胆汁性肝硬化中显著纤维化的性能；（2）肝硬度与 Mayo 评分预后指数之间的相关性。
连续纳入 120 例原发性胆汁性肝硬化患者。在肝活检时，将每种标志物和肝硬度的性能与组织学分期和 METAVIR 进行比较。
肝硬度的受试者工作特征（ROC）曲线下面积为组织学分期≥II、≥III 和=IV 的 0.87、0.88、0.99，METAVIR≥2、≥3 和=4 的 0.89、0.92、0.99。瞬时弹性成像单独在识别任何程度的纤维化或肝硬化方面优于非侵入性标志物。将每个替代标志物与瞬时弹性成像相结合并没有提高 ROC 的曲线下面积。瞬时弹性成像与 Mayo 评分呈正相关（P<0.001）。逻辑回归分析显示，瞬时弹性成像与晚期纤维化相关（P<0.001）。
瞬时弹性成像被证明是一种简单、可靠且有用的方法，可用于评估原发性胆汁性肝硬化中的肝纤维化，而非侵入性替代标志物在预测显著纤维化方面表现不佳。
