Tamano Masaya, Kojima Kazuo, Akima Takashi, Murohisa Toshimitsu, Hashimoto Takashi, Uetake Chizu, Sugaya Takeshi, Nakano Masakazu, Hiraishi Hideyuki, Yoneda Masashi
Department of Gastroenterology, Dokkyo Medical University, Saitama, Japan.
Hepatogastroenterology. 2012 May;59(115):826-30. doi: 10.5754/hge11255.
BACKGROUND/AIMS: The degree of hepatic fibrosis is an important factor for prognosis and management of patients with chronic liver disease; however, liver biopsy is an invasive method of measuring fibrosis. Here, we investigated the diagnostic utility of liver stiffness, as measured by transient elastography in assessing hepatic fibrosis of viral chronic liver disease and nonalcoholic fatty liver disease (NAFLD).
Four hundred and nine eligible patients underwent transient elastography to measure liver stiffness. Liver biopsy for histopathological assessment of fibrosis (F0-F4) was performed in 71 of these patients. Serum levels of hyaluronic acid were determined in 110 patients. We assessed liver stiffness in several chronic liver diseases and compared correlations among liver stiffness, hepatic fibrosis stage and serum hyaluronic acid levels.
A steady stepwise increase in liver stiffness was observed with progressing severity of hepatic fibrosis (p<0.0001) in 71 patients who underwent liver biopsy. In 32 chronic viral hepatitis patients, measuring liver stiffness was useful for differentiating between F1, or F2, or F3 and F4, while in 32 NAFLD liver stiffness can differentiate between F0 and F1, F2, or F3, F1 and F3 or F4 and F2 and F4. There was no significant correlation between liver fibrotic stages and serum hyaluronic levels.
The present data advocates measuring liver stiffness for assessing hepatic fibrosis is more sensitive in NAFLD than viral chronic diseases, and liver stiffness is useful compared to serum hyaluronic acid level in estimating hepatic fibrosis.
背景/目的：肝纤维化程度是慢性肝病患者预后和管理的重要因素；然而，肝活检是一种测量纤维化的侵入性方法。在此，我们研究了通过瞬时弹性成像测量的肝脏硬度在评估病毒性慢性肝病和非酒精性脂肪性肝病（NAFLD）肝纤维化中的诊断效用。
409名符合条件的患者接受了瞬时弹性成像以测量肝脏硬度。其中71名患者进行了肝活检以进行纤维化的组织病理学评估（F0 - F4）。110名患者测定了血清透明质酸水平。我们评估了几种慢性肝病的肝脏硬度，并比较了肝脏硬度、肝纤维化阶段和血清透明质酸水平之间的相关性。
在71名接受肝活检的患者中，随着肝纤维化严重程度的进展，观察到肝脏硬度呈稳定的逐步增加（p<0.0001）。在32名慢性病毒性肝炎患者中，测量肝脏硬度有助于区分F1、F2或F3与F4，而在32名NAFLD患者中，肝脏硬度可区分F0与F1、F2或F3，F1与F3或F4以及F2与F4。肝纤维化阶段与血清透明质酸水平之间无显著相关性。
目前的数据表明，在评估肝纤维化方面，测量肝脏硬度在NAFLD中比病毒性慢性疾病更敏感，并且在估计肝纤维化方面，肝脏硬度比血清透明质酸水平更有用。
