Department of Hepatology, Institute of Post Graduate Medical Education & Research, Kolkata, India.
Hepatology. 2012 Feb;55(2):584-93. doi: 10.1002/hep.24694. Epub 2011 Dec 29.
The liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 healthy subjects with normal alanine aminotransferase (ALT) levels, recruited from a free-living population of the Birbhum Population Project (BIRPOP; www.shds.in), a Health and Demographic Surveillance System (HDSS), and from 274 patients with liver disease attending the Hepatology Clinic of the School of Digestive and Liver Diseases (SDLD; Institute of Post Graduate Medical Education & Research [IPGME&R], Kolkata, India) including 188 with nonalcoholic fatty liver disease (NAFLD) and 86 with chronic hepatitis of viral and other etiologies. Liver biopsy was performed in 125 patients. The range of normal values for LSM, defined by 5th and 95th percentile values in healthy subjects, was 3.2 and 8.5 kPa, respectively. Healthy subjects with a lower body mass index (BMI; < <18.5 kg/m(2)) had a higher LSM compared with subjects who had a normal BMI; this LSM value was comparable to that of obese subjects (6.05 ± 1.78 versus 5.51 ± 1.59 and 6.60 ± 1.21, P = 0.016 and 0.349, respectively). Liver disease patients without histologic fibrosis had significantly higher LSM values compared with healthy subjects (7.52 ± 5.49 versus 5.63 ± 1.64, P < 0.001). Among the histologic variables, stage of fibrosis was the only predictor for LSM. LSM did not correlate with inflammatory activity and ALT in both NAFLD and chronic hepatitis groups.
LSM varies between 3.2 and 8.5 kPa in healthy subjects of South Asian origin. Both lean and obese healthy subjects have higher LSM values compared with subjects with normal BMI. Liver stiffness begins to increase even before fibrosis appears in patients with liver disease.
本研究旨在探究肝硬度测量（LSM）在不同种族和人体测量学特征的健康人群（以建立可接受的正常范围）中的应用，以及在肝脏疾病患者中的应用。为了实现这一目标，我们使用 FibroScan 通过瞬时弹性成像（TE）对 437 名丙氨酸氨基转移酶（ALT）正常的 BIRPOP 研究人群（www.shds.in）和 274 名肝脏疾病患者（印度加尔各答的 SDLS 消化和肝脏疾病学院）进行了 LSM 检测，包括 188 名非酒精性脂肪性肝病（NAFLD）患者和 86 名病毒性和其他病因的慢性肝炎患者。125 名患者进行了肝活检。通过健康人群第 5 百分位和第 95 百分位值定义的 LSM 正常范围分别为 3.2kPa 和 8.5kPa。与正常 BMI 人群相比，BMI<18.5kg/m2 的健康人群 LSM 更高；与肥胖人群相比，该 LSM 值相当（分别为 6.05±1.78 与 5.51±1.59 和 6.60±1.21，P=0.016 和 0.349）。无组织学纤维化的肝病患者的 LSM 值显著高于健康人群（7.52±5.49 与 5.63±1.64，P<0.001）。在组织学变量中，纤维化分期是 LSM 的唯一预测因素。LSM 在 NAFLD 和慢性肝炎组中均与炎症活动和 ALT 无相关性。
南亚裔健康人群的 LSM 值在 3.2kPa 和 8.5kPa 之间变化。瘦人和肥胖的健康人群的 LSM 值均高于正常 BMI 人群。在肝脏疾病患者中，即使在出现纤维化之前，肝硬度也开始增加。
