应用 Fibroscan 预测慢性乙型肝炎患者发生肝相关事件的研究。
Prediction of liver-related events using fibroscan in chronic hepatitis B patients showing advanced liver fibrosis.
机构信息
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
出版信息
PLoS One. 2012;7(5):e36676. doi: 10.1371/journal.pone.0036676. Epub 2012 May 4.
BACKGROUND
Liver stiffness measurement (LSM) using transient elastography (FibroScan®) can assess liver fibrosis noninvasively. This study investigated whether LSM can predict the development of liver-related events (LREs) in chronic hepatitis B (CHB) patients showing histologically advanced liver fibrosis.
METHODS
Between March 2006 and April 2010, 128 CHB patients with who underwent LSM and liver biopsy (LB) before starting nucleot(s)ide analogues and showed histologically advanced fibrosis (≥F3) with a high viral loads [HBV DNA ≥2,000 IU/mL] were enrolled. All patients were followed regularly to detect LRE development, including hepatic decompensation (variceal bleeding, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome) and hepatocellular carcinoma (HCC).
RESULTS
The mean age of the patient (72 men, 56 women) was 52.2 years. During the median follow-up period [median 27.8 (12.6-61.6) months], LREs developed in 19 (14.8%) patients (five with hepatic decompensation, 13 with HCC, one with both). Together with age, multivariate analysis identified LSM as an independent predictor of LRE development [P<0.044; hazard ratio (HR), 1.038; 95% confidence interval (CI), 1.002-1.081]. When the study population was stratified into two groups using the optimal cutoff value (19 kPa), which maximized the sum of sensitivity (61.1%) and specificity (86.2%) from a time-dependent receiver operating characteristic curve, patients with LSM>19 kPa were at significantly greater risk than those with LSM≤19 kPa for LRE development (HR, 7.176; 95% CI, 2.257-22.812; P = 0.001).
CONCLUSION
LSM can be a useful predictor of LRE development in CHB patients showing histologically advanced liver fibrosis.
背景
瞬时弹性成像（FibroScan®）的肝脏硬度测量（LSM）可无创评估肝纤维化。本研究旨在探讨 LSM 是否可预测组织学上显示晚期纤维化（≥F3）且病毒载量较高（HBV DNA≥2,000 IU/mL）的慢性乙型肝炎（CHB）患者发生肝脏相关事件（LREs）。
方法
2006 年 3 月至 2010 年 4 月，128 例开始核苷（酸）类似物治疗前接受 LSM 和肝活检（LB）且组织学上显示晚期纤维化（≥F3）且病毒载量较高的 CHB 患者，入选本研究。所有患者均定期随访以检测 LRE 发生情况，包括肝失代偿（静脉曲张出血、腹水、肝性脑病、自发性细菌性腹膜炎、肝肾综合征）和肝细胞癌（HCC）。
结果
患者（72 例男性，56 例女性）的平均年龄为 52.2 岁。中位随访期间（中位 27.8[12.6-61.6]个月），19 例（14.8%）患者发生 LREs（5 例肝失代偿，13 例 HCC，1 例同时发生肝失代偿和 HCC）。多变量分析将 LSM 与年龄一起确定为 LRE 发生的独立预测因子[P<0.044；风险比（HR），1.038；95%置信区间（CI），1.002-1.081]。使用时间依赖性受试者工作特征曲线的最佳截断值（19 kPa）将研究人群分为两组，最大程度地提高了敏感性（61.1%）和特异性（86.2%）的总和，LSM>19 kPa 的患者发生 LRE 的风险显著高于 LSM≤19 kPa 的患者（HR，7.176；95%CI，2.257-22.812；P=0.001）。
结论
在组织学上显示晚期纤维化的 CHB 患者中，LSM 可作为 LRE 发生的有用预测因子。
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