Rath Timo, Roderfeld Martin, Güler Can, Wenzel Christian, Graf Jürgen, Beitinger Frigga, Roeb Elke, Zachoval Reinhart
Department of Internal Medicine, Division of Gastroenterology, Justus-Liebig-University Giessen, Giessen, Germany.
Scand J Gastroenterol. 2011 Nov;46(11):1369-80. doi: 10.3109/00365521.2011.613949. Epub 2011 Sep 12.
Transient elastography (TE) is a non-invasive and accurate method for the diagnosis of severe hepatic fibrosis and cirrhosis (F = 3 and F = 4). However, the assessment of significant fibrosis (F = 2) by TE is impaired due to a high variation in the diagnostic accuracy. Within this study, we aim to compare the diagnostic value of TE and experimental biomarkers of liver fibrosis.
A total of 55 patients with chronic liver disease of different etiologies were included in the study. Among them, patients with HCV infection represented the largest cohort (n = 25). Liver fibrosis was evaluated according to the Desmet/Scheuer score. All patients received TE. Serum concentrations of YKL-40, hyaluronic acid (HA), Laminin, C-terminal procollagen I peptide, MMP-9, TIMP-1, TIMP-2 and MMP-9/TIMP-1 complex were determined by ELISA.
In the total patient population, areas under the receiver operator characteristic curve (AUROC) for TE were 0.798 (F ≥ 2), 0.880 (F ≥ 3) and 1 (F = 4). Among the serum markers, highest diagnostic accuracies were calculated for YKL-40 for F ≥ 2 (0.792) and F ≥ 3 (0.914) and for YKL-40 and HA for F = 4 (both 0.936). In the subgroup of HCV patients, the following AUROCs for TE were calculated: 0.802 (F ≥ 2), 0.798 (F ≥ 3) and 0.998 (F = 4). YKL-40 exhibited the highest diagnostic accuracy of all biomarkers in the HCV population (0.880, 0.854 and 0.986, respectively).
YKL-40 is a powerful fibrosis marker with high diagnostic accuracy, in particular in HCV-associated liver disease. Its determination may confirm and improve the diagnostic accuracy of TE especially in early stages of liver fibrosis.
瞬时弹性成像（TE）是诊断严重肝纤维化和肝硬化（F = 3和F = 4）的一种非侵入性准确方法。然而，由于诊断准确性差异较大，TE对显著纤维化（F = 2）的评估受到影响。在本研究中，我们旨在比较TE与肝纤维化实验生物标志物的诊断价值。
本研究共纳入55例不同病因的慢性肝病患者。其中，丙型肝炎病毒（HCV）感染患者占最大队列（n = 25）。根据Desmet/Scheuer评分评估肝纤维化。所有患者均接受TE检查。采用酶联免疫吸附测定法（ELISA）测定血清中YKL-40、透明质酸（HA）、层粘连蛋白、I型前胶原C端肽、基质金属蛋白酶-9（MMP-9）、金属蛋白酶组织抑制因子-1（TIMP-1）、金属蛋白酶组织抑制因子-2（TIMP-2）及MMP-9/TIMP-1复合物的浓度。
在全部患者群体中，TE的受试者工作特征曲线下面积（AUROC）分别为：F≥2时为0.798，F≥3时为0.880，F = 4时为1。在血清标志物中，YKL-40对F≥2（0.792）和F≥3（0.914）的诊断准确性最高，YKL-40和HA对F = 4的诊断准确性最高（均为0.936）。在HCV患者亚组中，TE的AUROC分别为：F≥2时为0.802，F≥3时为0.798，F = 4时为0.998。在HCV人群中，YKL-40在所有生物标志物中诊断准确性最高（分别为0.880、0.854和0.986）。
YKL-40是一种诊断准确性高的强大纤维化标志物，尤其在HCV相关肝病中。其测定可能会证实并提高TE的诊断准确性，特别是在肝纤维化早期。
