磁共振弹性成像和生物标志物评估肝移植受者丙型肝炎复发引起的纤维化。
Magnetic resonance elastography and biomarkers to assess fibrosis from recurrent hepatitis C in liver transplant recipients.
机构信息
Division of Hepatology, Northwestern University Feinberg School of Medicine, 676 N. Street Clair, Chicago, IL 60611, USA.
出版信息
Transplantation. 2011 Sep 15;92(5):581-6. doi: 10.1097/TP.0b013e31822805fa.
BACKGROUND
Imaging techniques evaluating liver stiffness (magnetic resonance elastography [MRE]) and biomarkers may be useful indicators of fibrosis stage in hepatitis C virus (HCV)+patients. Our aim was to compare the accuracy of MRE and biomarkers in staging fibrosis because of recurrent HCV in liver transplant (LT) recipients with hepatocellular carcinoma.
METHODS
Liver magnetic resonance imaging and MRE, FIBROSpectII, aspartate aminotransferase-to-platelet ratio index (aspartate aminotransferase [AST]: platelet index), AST:alanine aminotransferase ratio, and magnetic resonance imaging/MRE-guided biopsies targeting the stiffest regions (right and left lobes) were performed in HCV+LT recipients. Sensitivity, specificity, positive predictive value (PPV)/negative predictive value (NPV), and likelihood ratios were calculated for the best cutoff by receiver operating characteristic analysis.
RESULTS
Thirty-two recipients were included: 28 men, age 60 (±6.4) years, and time since LT 3.25 (±1.68) years. Both MRE (P=0.0001) and FIBROSpectII (P=0.009) were significantly different between no fibrosis and more than or equal to stage 1 groups, whereas aspartate aminotransferase-to-platelet ratio index and AST:alanine aminotransferase ratio were not different. Areas under the receiver operating characteristic curve were 0.87 for MRE and 0.84 for FIBROSpectII. MRE cutoff of 3.81 kPa had 87.5% sensitivity, 79.2% specificity, 58.3% PPV, and 95.0% NPV; FIBROSpectII cutoff of 42 had 87.5% sensitivity, 70.0% specificity, 53.8% PPV, and 93.3% NPV for detection of more than or equal to stage 1 fibrosis. Two patients had high MRE values because of unexpected acute rejection and portal vein thrombosis.
CONCLUSIONS
MRE and FIBROSpectII are highly sensitive in detecting fibrosis due to recurrent HCV. Both are limited by the low specificity/PPV and confounding because of other graft complications. Values below the MRE and FIBROSpectII cutoffs, however, strongly suggest the absence of fibrosis and may avert the need for protocol biopsy staging.
背景
评估肝脏硬度的影像学技术（磁共振弹性成像[MRE]）和生物标志物可能是丙型肝炎病毒（HCV）+患者纤维化分期的有用指标。我们的目的是比较 MRE 和生物标志物在评估因 HCV 复发导致肝移植（LT）受者肝细胞癌的纤维化分期中的准确性。
方法
对 HCV+LT 受者进行肝脏磁共振成像和 MRE、FIBROSpectII、天冬氨酸氨基转移酶-血小板比值指数（AST：血小板指数）、AST：丙氨酸氨基转移酶比值以及针对最硬区域（右叶和左叶）的磁共振成像/MRE 引导活检。通过受试者工作特征分析计算最佳截断值的敏感性、特异性、阳性预测值（PPV）/阴性预测值（NPV）和似然比。
结果
共纳入 32 例受者，均为男性，年龄 60（±6.4）岁，LT 后时间 3.25（±1.68）年。MRE（P=0.0001）和 FIBROSpectII（P=0.009）在无纤维化和≥1 期组之间差异均有统计学意义，而 AST：血小板比值指数和 AST：丙氨酸氨基转移酶比值差异无统计学意义。MRE 的受试者工作特征曲线下面积为 0.87，FIBROSpectII 的为 0.84。MRE 截断值为 3.81 kPa 时，敏感性为 87.5%，特异性为 79.2%，PPV 为 58.3%，NPV 为 95.0%；FIBROSpectII 截断值为 42 时，敏感性为 87.5%，特异性为 70.0%，PPV 为 53.8%，NPV 为 93.3%，用于检测≥1 期纤维化。两名患者因意外急性排斥反应和门静脉血栓形成而出现高 MRE 值。
结论
MRE 和 FIBROSpectII 在检测因 HCV 复发引起的纤维化方面具有高度敏感性。两种方法都受到特异性/PPV 较低和其他移植物并发症导致的混杂因素的限制。然而，低于 MRE 和 FIBROSpectII 截断值的值强烈提示不存在纤维化，可能避免了对协议活检分期的需要。
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