Fibroscan 对慢性病毒性肝炎临床管理的影响。
Impact of Fibroscan on management of chronic viral hepatitis in clinical practice.
机构信息
Van Creveldkliniek, Department of Haematology, Utrecht, The Netherlands.
出版信息
Ann Hepatol. 2011 Oct-Dec;10(4):469-76.
BACKGROUND
Liver stiffness measurement (LSM) using Fibroscan is an increasingly popular non-invasive method for quantifying liver fibrosis in patients with chronic viral hepatitis. We aimed to explore potential impact of Fibroscan on clinical management.
MATERIAL AND METHODS
133 patients with chronic hepatitis B (HBV, n = 75) or C (HCV, n = 58) underwent Fibroscan measurement. LSM results were compared with liver biopsy results, ultrasound, and APRI-scores, and the impact of LSM on clinical management was evaluated.
RESULTS
LSM results indicated fibrosis stage F0-F1 in 84 patients (63%), F2 in 28 (21%), F3 in 8 (6%), and F4 in 13 patients (10%). Nineteen patients had liver biopsies within one year of LSM. In ten patients, LSM and biopsy showed the same fibrosis stage, in 8 there was one stage difference, and in 1 three stages difference. Ultrasound only showed cirrhosis in three patients, who all exhibited advanced cirrhosis at LSM. There was a statistically significant, but weak correlation between LSM results and APRI scores (r = 0.31, pvalue < 0.001). LSM results changed clinical management in 39% of patients (55 cases): in 15 patients antiviral treatment was indicated, in 21 patients surveillance for hepatocellular carcinoma was indicated, and 19 successfully treated hepatitis C patients could be discharged from clinical follow-up in absence of severe fibrosis or cirrhosis.
CONCLUSION
LSM appears to be a valuable non-invasive tool to manage patients with chronic viral hepatitis in clinical practice.
背景
使用 Fibroscan 进行肝硬度测量（LSM）是一种越来越流行的量化慢性病毒性肝炎患者肝纤维化的非侵入性方法。我们旨在探讨 Fibroscan 对临床管理的潜在影响。
材料与方法
133 例慢性乙型肝炎（HBV，n=75）或丙型肝炎（HCV，n=58）患者接受 Fibroscan 测量。将 LSM 结果与肝活检结果、超声和 APRI 评分进行比较，并评估 LSM 对临床管理的影响。
结果
LSM 结果显示 84 例患者（63%）纤维化分期为 F0-F1，28 例（21%）为 F2，8 例（6%）为 F3，13 例（10%）为 F4。19 例患者在 LSM 后一年内进行了肝活检。在 10 例患者中，LSM 和活检显示相同的纤维化分期，8 例患者相差一个分期，1 例患者相差三个分期。超声仅在 3 例患者中显示肝硬化，而这 3 例患者在 LSM 时均显示晚期肝硬化。LSM 结果与 APRI 评分之间存在统计学上显著但较弱的相关性（r=0.31，p 值<0.001）。LSM 结果改变了 39%（55 例）患者的临床管理：15 例患者需要抗病毒治疗，21 例患者需要监测肝细胞癌，19 例丙型肝炎成功治疗的患者在没有严重纤维化或肝硬化的情况下可以从临床随访中出院。
结论
LSM 似乎是一种有价值的非侵入性工具，可用于临床实践中管理慢性病毒性肝炎患者。
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