肝硬度测量与肝活检预测 HIV/丙型肝炎病毒合并感染患者的生存和失代偿情况。

Liver stiffness measurement versus liver biopsy to predict survival and decompensations of cirrhosis among HIV/hepatitis C virus-coinfected patients.

机构信息

aInfectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla, Seville bInfectious Diseases Unit, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Cordoba cInfectious Diseases Unit, Hospital Donostia, San Sebastian dInstituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville eInfectious Diseases Unit, Hospital General Universitario de Valencia, Valencia fInternal Medicine Service, FundacióLluita Contra la SIDA, University Hospital GermansTrias I Pujol, UniversitatAutònoma de Barcelona, Barcelona gInfectious Diseases Unit, Hospital Universitario Virgen Macarena, Seville hInfectious Diseases Unit, Complejo Hospitalario de Huelva, Huelva iInfectious Diseases Unit, Hospital de La Línea de la Concepción, Cadiz jInfectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain.

出版信息

AIDS. 2013 Oct 23;27(16):2541-9. doi: 10.1097/QAD.0b013e32836381f3.

DOI:10.1097/QAD.0b013e32836381f3

PMID:23736148

Abstract

OBJECTIVE

To compare the prognostic performance of liver biopsy with that of liver stiffness measurement (LSM) to predict survival and liver decompensations among HIV/hepatitis C virus (HCV)-coinfected patients.

DESIGN

Retrospective cohort study.

METHODS

Cohort of 297 HIV/HCV-coinfected patients, who underwent a liver biopsy and LSM separated by 12 months or less, followed in 10 Spanish tertiary care centers from December 2005 to December 2011 (median follow-up, 5 years; interquartile range, 4.2-5.4 years). Liver biopsies were staged following the Scheuer's score. LSM was obtained by hepatic transient elastometry. A survival analysis was carried out and the integrated discrimination improvement was computed to compare the ability of the survival models to predict outcomes. The incidence of death from any cause and of development of the first decompensation of cirrhosis was calculated.

RESULTS

Overall mortality rate was 1.63 [95% confidence interval (CI) 1.06-2.49] per 100 person-years. The adjusted hazard ratio [AHR (95% CI)] of baseline fibrosis (per stage of fibrosis) was 1.52 (1.08-2.15, P=0.017) and of LSM (per 5 kPa increase) 1.28 (1.12-1.46, P<0.001). LSM including models yielded a performance 3.9% better than the liver biopsy-based models (P=0.072). For the prediction of liver decompensations, the AHR (95% CI) of baseline fibrosis by liver biopsy (per stage of fibrosis) was 1.67 (1.15-2.43, P=0.007) and of LSM (per 5 kPa increase) 1.37 (1.21-1.54, P<0.001). LSM-based models yielded a performance 8.4% better than the liver biopsy-based models (P=0.045).

CONCLUSION

LSM-based prediction achieves a similar yield than liver biopsy-based models to predict overall mortality in HIV/HCV-coinfected patients. Models including LSM could predict better liver decompensations than liver biopsy.

摘要

目的

比较肝活检和肝硬度测量（LSM）对预测 HIV/丙型肝炎病毒（HCV）合并感染患者生存和肝功能失代偿的预后效能。

设计

回顾性队列研究。

方法

研究纳入了 297 例于 2005 年 12 月至 2011 年 12 月在西班牙 10 个三级保健中心接受了间隔 12 个月或更短时间的肝活检和 LSM 的 HIV/HCV 合并感染患者。肝活检根据 Scheuer 评分进行分期。LSM 通过瞬时弹性成像技术获得。进行生存分析，并计算综合判别改善以比较生存模型预测结局的能力。计算任何原因导致的死亡率和首次肝硬化失代偿的发生率。

结果

总死亡率为 1.63 [95%置信区间（CI）1.06-2.49] / 100 人年。基线纤维化（每 stage 纤维化）的调整后危险比（AHR （95%CI））为 1.52（1.08-2.15，P=0.017），LSM（每增加 5 kPa）为 1.28（1.12-1.46，P<0.001）。包含 LSM 的模型比基于肝活检的模型性能提高了 3.9%（P=0.072）。对于预测肝功能失代偿，肝活检（每 stage 纤维化）的基线纤维化的 AHR （95%CI）为 1.67（1.15-2.43，P=0.007），LSM（每增加 5 kPa）为 1.37（1.21-1.54，P<0.001）。基于 LSM 的模型比基于肝活检的模型性能提高了 8.4%（P=0.045）。