Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands.
Liver Int. 2012 Apr;32(4):622-8. doi: 10.1111/j.1478-3231.2011.02663.x. Epub 2011 Oct 17.
Fibrosis determines prognosis and management in patients with chronic hepatitis B and C (CHB and CHC). Transient elastography (TE) is a promising non-invasive method to assess fibrosis. We prospectively studied the performance of TE compared to histology and also whether there are differences between CHB and CHC. Only large biopsies (≥ 25 mm) were used.
We included 241 patients with CHB (n = 125) and CHC (n = 116), of whom we acquired 257 liver biopsies, all preceded by elastography. We correlated liver stiffness with fibrosis stage according to the METAVIR system, inflammation (Histology Activity Index), steatosis and iron. The impact of gender, age, body mass index, alcohol, alanine aminotransferase levels, platelet count, viral load and genotype on liver stiffness was evaluated.
The AUROC's for F ≥ 2 were 0.85 for CHB and 0.76 for CHC. AUROC's for F ≥ 3 were 0.91 for CHB and 0.87 for CHC and 0.90 and 0.91 for F4 for CHB and CHC respectively. For F ≥ 2 the cut-off value was 6.0 kPa for CHB and 5.0 kPa for CHC. The cut-off values for ≥ F3 were 9.0 and 8.0 kPa for CHB and CHC, respectively, and 13.0 kPa for F4 in both CHB and CHC patients. Besides inflammation, all other remaining factors do not influence liver stiffness.
For the diagnosis of fibrosis stages F ≤ 2 TE is suboptimal, and inflammation may induce higher values. For stages F ≥ 3 TE performance is good and equal in both CHB and CHC patients.
纤维化决定了慢性乙型肝炎和丙型肝炎（CHB 和 CHC）患者的预后和治疗。瞬时弹性成像（TE）是一种有前途的非侵入性方法，可用于评估纤维化。我们前瞻性地研究了 TE 与组织学的表现，并探讨了 CHB 和 CHC 之间是否存在差异。仅使用大活检（≥25mm）。
我们纳入了 241 例 CHB（n=125）和 CHC（n=116）患者，共获得 257 例肝活检，均在弹性成像之前进行。我们根据 METAVIR 系统将肝硬度与纤维化分期、炎症（组织学活动指数）、脂肪变性和铁相关联。评估了性别、年龄、体重指数、酒精、丙氨酸氨基转移酶水平、血小板计数、病毒载量和基因型对肝硬度的影响。
F≥2 的 AUROC 为 0.85（CHB）和 0.76（CHC）。F≥3 的 AUROC 为 0.91（CHB）和 0.87（CHC），F4 的 AUROC 为 0.90（CHB）和 0.91（CHC）。对于 F≥2，CHB 的临界值为 6.0kPa，CHC 的临界值为 5.0kPa。对于 F≥3，CHB 和 CHC 的临界值分别为 9.0kPa 和 8.0kPa，而 CHB 和 CHC 中 F4 的临界值为 13.0kPa。除炎症外，所有其他剩余因素均不影响肝硬度。
对于纤维化分期 F≤2，TE 表现不佳，炎症可能导致更高的值。对于 F≥3，TE 的表现良好，在 CHB 和 CHC 患者中表现相同。
