慢性肝病患者腹腔镜肝活检与弹性测量（FibroScan）的相关性
Correlation of Laparoscopic Liver Biopsy to Elasticity Measurements (FibroScan) in Patients With Chronic Liver Disease.
作者信息
Nudo Carmine G, Jeffers Lennox J, Bejarano Pablo A, Servin-Abad Luis A, Leibovici Zvi, De Medina Maria, Schiff Eugene R
机构信息
Dr. Nudo, Dr. Jeffers, Dr. Servin-Abad, Mr. Leibovici, Ms. De Medina, and Dr. Schiff are affiliated with the Center for Liver Diseases and Division of Hepatology at the University of Miami Leonard M. Miller School of Medicine in Miami, Florida, where Dr. Bejarano is associated with the Department of Pathology.
出版信息
Gastroenterol Hepatol (N Y). 2008 Dec;4(12):862-70.
BACKGROUND
Elastography is a noninvasive method to assess liver fibrosis by measuring liver stiffness. Studies have compared elas-tography to percutaneous biopsy. Laparoscopic biopsy is associated with decreased sampling error compared to percutaneous biopsy, as laparoscopic biopsies are obtained from both liver lobes and gross nodu-larity can be visualized.
METHODS
Patients undergoing laparoscopic liver biopsy were enrolled. Gross liver appearance was assessed, and biopsy specimens were blindly evaluated by a pathologist. Elastography (FibroScan) was used to measure liver stiffness.
RESULTS
101 patients were examined. Fibrosis was related to elasticity (Spearman correlation r=0.63; P<.0001). Elasticity was strongly associated with advanced stages of fibrosis (stages 3 and 4; Spearman correlation r(2)=0.44; P<.001). Significant fibrosis was associated with an irregular liver surface, nodularity, and thickened edge (multiple regression r(2)=0.41; P<.001). Increased elasticity was associated with a fatty-appearing liver, irregular surface, firmness, and nodularity (multiple regression r(2)=0.46; P<.001). Receiver operating characteristic curve for elasticity for identifying patients with a liver fibrosis stage of at least 3 or of 4 had an area under the curve (AUC) of 0.85 or 0.86, respectively. AUC was 0.857 when gross nodularity was used as the gold standard for cirrhosis and 0.875 when nodularity/histology were used. Elasticity of at least 7 kPa, at least 9.5 kPa, and at least 11.8 kPa had the highest accuracy for identifying patients with a fibrosis stage of at least 2, at least 3, and 4, respectively. In hepatitis C patients, AUC was 0.921, 0.882, and 0.925 when histology, gross nodularity, and nodularity/histology, respectively, were used as the gold standard for cirrhosis.
CONCLUSION
FibroScan could be useful for detecting advanced stages of fibrosis when validated against laparoscopic liver biopsy.
背景
弹性成像技术是一种通过测量肝脏硬度来评估肝纤维化的非侵入性方法。已有研究将弹性成像与经皮肝穿刺活检进行了比较。与经皮肝穿刺活检相比，腹腔镜活检的取样误差较小，因为腹腔镜活检取自肝脏的两个叶，且可以观察到肝脏的大体结节情况。
方法
纳入接受腹腔镜肝活检的患者。评估肝脏的大体外观，并由病理学家对活检标本进行盲法评估。使用弹性成像（FibroScan）测量肝脏硬度。
结果
共检查了101例患者。纤维化与弹性相关（Spearman相关系数r = 0.63；P <.0001）。弹性与纤维化的晚期阶段（3期和4期）密切相关（Spearman相关系数r(2)= 0.44；P <.001）。显著纤维化与肝脏表面不规则、结节形成和边缘增厚相关（多元回归r(2)= 0.41；P <.001）。弹性增加与肝脏呈脂肪样外观、表面不规则、质地坚硬和结节形成相关（多元回归r(2)= 0.46；P <.001）。用于识别肝纤维化分期至少为3期或4期患者的弹性的受试者工作特征曲线，其曲线下面积（AUC）分别为0.85或0.86。当将大体结节作为肝硬化的金标准时，AUC为0.857；当使用结节/组织学作为金标准时，AUC为0.875。弹性至少为7 kPa、至少为9.5 kPa和至少为11.8 kPa时，分别对识别纤维化分期至少为2期、至少为3期和4期的患者具有最高的准确性。在丙型肝炎患者中，当分别将组织学、大体结节和结节/组织学作为肝硬化金标准时，AUC分别为0.921、0.882和0.925。
结论
与腹腔镜肝活检对照验证时，FibroScan可能有助于检测纤维化的晚期阶段。
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