Center of Infectious Diseases, West China Hospital Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.
Hepatol Res. 2013 Feb;43(2):185-91. doi: 10.1111/j.1872-034X.2012.01068.x. Epub 2012 Sep 16.
The accuracy of liver stiffness measurement (LSM) in the diagnosis of liver fibrosis is affected by elevated serum alanine aminotransferase (ALT) levels. The aim of this study was to assess the impact of mild to moderate elevations of ALT on LSM in patients with chronic hepatitis B (CHB) during antiviral therapy.
A total of 58 CHB patients with their ALT levels falling into the range of ×2 to ×10 the upper limit of normal (ULN) were recruited. ALT and LSM values were periodically assessed at baseline and 12, 24 and 48 weeks.
The median ALT levels were 153.5 (76-544), 50.5 (11-475), 36.5 (9-265) and 30 (12-239) IU/L at baseline and 12, 24 and 48 weeks, respectively. The corresponding median value of LSM was 8.8 (3.2-47.3), 6.15 (3.2-31.2), 5.9 (3.1-29.1) and 5.5 (2.8-21.5) kpa. However, after the ALT levels were normalized by the treatment, the values of LSM did not vary significantly (6.1 [3.0-17.7] vs 5.25 [2.8-21.5] kpa, P = 0.381). Pretreatment fibrosis stages of liver biopsies corresponded with LSM after ALT normalization rather than baseline LSM (F0-1, 12/27 vs 23/25, P < 0.001).
The LSM values decreased in parallel with the decline in ALT levels in CHB patients with mild to moderate elevation of ALT. LSM became more accurate when applied to document the liver fibrosis or cirrhosis in CHB patients after the elevated ALT level has been treated to normal level.
肝硬度测量（LSM）在诊断肝纤维化中的准确性受血清丙氨酸氨基转移酶（ALT）水平升高的影响。本研究旨在评估慢性乙型肝炎（CHB）患者抗病毒治疗期间轻度至中度 ALT 升高对 LSM 的影响。
共招募了 58 例 ALT 水平处于正常上限（ULN）2 倍至 10 倍范围内的 CHB 患者。在基线和 12、24 和 48 周时定期评估 ALT 和 LSM 值。
基线时和 12、24 和 48 周时的中位 ALT 水平分别为 153.5（76-544）、50.5（11-475）、36.5（9-265）和 30（12-239）IU/L，相应的 LSM 中位数分别为 8.8（3.2-47.3）、6.15（3.2-31.2）、5.9（3.1-29.1）和 5.5（2.8-21.5）kPa。然而，在 ALT 水平经治疗正常化后，LSM 值没有显著变化（6.1[3.0-17.7]与 5.25[2.8-21.5]kPa，P=0.381）。经 ALT 正常化后，肝活检的纤维化分期与 LSM 相对应，而不是与基线 LSM 相对应（F0-1，12/27 与 23/25，P<0.001）。
在 ALT 轻度至中度升高的 CHB 患者中，LSM 值随 ALT 水平的下降而降低。当将 LSM 应用于记录 ALT 水平升高的 CHB 患者的肝纤维化或肝硬化时，其在 ALT 水平正常化后更为准确。
