肝活检与 Fibroscan® 在评估慢性乙型肝炎肝纤维化中的差异：危险因素和坏死炎症的影响。
Discordance between liver biopsy and Fibroscan® in assessing liver fibrosis in chronic hepatitis b: risk factors and influence of necroinflammation.
机构信息
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
出版信息
PLoS One. 2012;7(2):e32233. doi: 10.1371/journal.pone.0032233. Epub 2012 Feb 23.
BACKGROUND
Few studies have investigated predictors of discordance between liver biopsy (LB) and liver stiffness measurement (LSM) using FibroScan®. We assessed predictors of discordance between LB and LSM in chronic hepatitis B (CHB) and investigated the effects of necroinflammatory activity.
METHODS
In total, 150 patients (107 men, 43 women) were prospectively enrolled. Only LSM with ≥ 10 valid measurements was considered reliable. Liver fibrosis was evaluated using the Laennec system. LB specimens <15 mm in length were considered ineligible. Reference cutoff LSM values to determine discordance were calculated from our cohort (6.0 kPa for ≥ F2, 7.5 kPa for ≥ F3, and 9.4 kPa for F4).
RESULTS
A discordance, defined as a discordance of at least two stages between LB and LSM, was identified in 21 (14.0%) patients. In multivariate analyses, fibrosis stages F3-4 and F4 showed independent negative associations with discordance (P = 0.002; hazard ratio [HR], 0.073; 95% confidence interval [CI], 0.014-0.390 for F3-4 and P = 0.014; HR, 0.067; 95% CI, 0.008-0.574 for F4). LSM values were not significantly different between maximal activity grades 1-2 and 3-4 in F1 and F2 fibrosis stages, whereas LSM values were significantly higher in maximal activity grade 3-4 than 1-2 in F3 and F4 fibrosis stage (median 8.6 vs. 11.3 kPa in F3, P = 0.049; median 11.9 vs. 19.2 kPa in F4, P = 0.009).
CONCLUSION
Advanced fibrosis stage (F3-4) or cirrhosis (F4) showed a negative correlation with discordance between LB and LSM in patients with CHB, and maximal activity grade 3-4 significantly influenced LSM values in F3 and F4.
背景
使用 FibroScan®进行肝活检（LB）和肝脏硬度测量（LSM）之间的不一致性的预测因素很少有研究。我们评估了慢性乙型肝炎（CHB）中 LB 和 LSM 之间不一致的预测因素，并研究了坏死性炎症活动的影响。
方法
共前瞻性纳入 150 例患者（男 107 例，女 43 例）。仅当≥10 次有效测量时，才认为 LSM 是可靠的。采用 Laennec 系统评估肝纤维化。长度<15mm 的 LB 标本被认为不合格。参考截断 LSM 值用于确定从我们的队列中确定不一致性（≥F2 为 6.0kPa，≥F3 为 7.5kPa，F4 为 9.4kPa）。
结果
在 21 例（14.0%）患者中确定了不一致性，定义为 LB 和 LSM 之间至少存在两个阶段的不一致性。多变量分析显示，纤维化分期 F3-4 和 F4 与不一致性呈独立负相关（P=0.002；风险比[HR]，0.073；95%置信区间[CI]，0.014-0.390，F3-4 和 P=0.014；HR，0.067；95%CI，0.008-0.574，F4）。在 F1 和 F2 纤维化分期中，最大活动度 1-2 级和 3-4 级之间的 LSM 值无显著差异，而在 F3 和 F4 纤维化分期中，最大活动度 3-4 级的 LSM 值明显高于 1-2 级（中位数 8.6 vs.11.3kPa，F3，P=0.049；中位数 11.9 vs.19.2kPa，F4，P=0.009）。
结论
在 CHB 患者中，晚期纤维化阶段（F3-4）或肝硬化（F4）与 LB 和 LSM 之间的不一致呈负相关，最大活动度 3-4 级显著影响 F3 和 F4 中的 LSM 值。
Zotero 插件