应用瞬时弹性成像技术评估输血相关性慢性丙型肝炎患者的疾病进展。
Assessment of disease progression in patients with transfusion-associated chronic hepatitis C using transient elastography.
机构信息
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 1138655 Tokyo, Japan.
出版信息
World J Gastroenterol. 2012 Mar 28;18(12):1385-90. doi: 10.3748/wjg.v18.i12.1385.
AIM
To evaluate the relationship between liver stiffness and duration of infection in blood transfusion-associated hepatitis C virus (HCV) patients with or without hepatocellular carcinoma (HCC).
METHODS
Between December 2006 and June 2008, a total of 524 transfusion-associated HCV-RNA positive patients with or without HCC were enrolled. Liver stiffness was obtained noninvasively by using Fibroscan (Echosens, Paris, France). The date of blood transfusion was obtained by interview. Duration of infection was derived from the interval between the date of blood transfusion and the date of liver stiffness measurement (LSM). Patients were stratified into four groups based on the duration of infection (17-29 years; 30-39 years; 40-49 years; and 50-70 years). The difference in liver stiffness between patients with and without HCC was assessed in each group. Multiple linear regression analysis was used to determine the factors associated with liver stiffness.
RESULTS
A total of 524 patients underwent LSM. Eight patients were excluded because of unsuccessful measurements. Thus 516 patients were included in the current analysis (225 with HCC and 291 without). The patients were 244 men and 272 women, with a mean age of 67.8 ± 9.5 years. The median liver stiffness was 14.3 kPa (25.8 in HCC group and 7.6 in non-HCC group). The patients who developed HCC in short duration of infection were male dominant, having lower platelet count, with a history of heavier alcohol consumption, showing higher liver stiffness, and receiving blood transfusion at an old age. Liver stiffness was positively correlated with duration of infection in patients without HCC (r = 0.132, P = 0.024) but not in patients with HCC (r = -0.103, P = 0.123). Liver stiffness was significantly higher in patients with HCC than in those without in each duration group (P < 0.0001). The factors significantly associated with high liver stiffness in multiple regression were age at blood transfusion (P < 0.0001), duration of infection (P = 0.0015), and heavy alcohol consumption (P = 0.043).
CONCLUSION
Although liver stiffness gradually increases over time, HCC develops in patients with high stiffness value regardless of the duration of infection.
目的
评估伴有或不伴有肝细胞癌（HCC）的输血相关丙型肝炎病毒（HCV）患者的肝硬度与感染持续时间之间的关系。
方法
2006 年 12 月至 2008 年 6 月期间，共纳入 524 例输血相关 HCV-RNA 阳性伴或不伴 HCC 的患者。使用 Fibroscan（Echosens，法国巴黎）非侵入性地获得肝硬度。通过访谈获得输血日期。感染持续时间由输血日期和肝硬度测量日期（LSM）之间的间隔得出。根据感染持续时间（17-29 年；30-39 年；40-49 年；和 50-70 年）将患者分为四组。在每组中评估伴有和不伴有 HCC 的患者之间的肝硬度差异。使用多元线性回归分析确定与肝硬度相关的因素。
结果
共对 524 例患者进行了 LSM。由于测量不成功，有 8 例患者被排除在外。因此，共有 516 例患者纳入当前分析（225 例伴 HCC，291 例无 HCC）。患者中 244 例为男性，272 例为女性，平均年龄为 67.8±9.5 岁。中位数肝硬度为 14.3kPa（HCC 组为 25.8kPa，非 HCC 组为 7.6kPa）。在感染持续时间较短的情况下发生 HCC 的患者以男性为主，血小板计数较低，有较重的饮酒史，肝硬度较高，输血年龄较大。在无 HCC 的患者中，肝硬度与感染持续时间呈正相关（r=0.132，P=0.024），但在 HCC 患者中无相关性（r=-0.103，P=0.123）。在每个持续时间组中，HCC 患者的肝硬度均明显高于无 HCC 患者（P<0.0001）。多元回归分析中与高肝硬度显著相关的因素为输血时年龄（P<0.0001）、感染持续时间（P=0.0015）和重度饮酒（P=0.043）。
结论
尽管肝硬度随时间逐渐增加，但无论感染持续时间如何，高肝硬度值的患者都会发生 HCC。
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