Fibroscan 可避免印度慢性乙型肝炎患者进行肝活检。

Fibroscan can avoid liver biopsy in Indian patients with chronic hepatitis B.

机构信息

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

出版信息

J Gastroenterol Hepatol. 2013 Nov;28(11):1738-45. doi: 10.1111/jgh.12318.

DOI:10.1111/jgh.12318

PMID:23808910

Abstract

BACKGROUND AND AIM

Liver fibrosis is an established determinant of prognosis and therapy in chronic hepatitis B (CHB). The role of fibroscan in assessing fibrosis in CHB remains unclear. Present study was designed to correlate fibroscan with liver biopsy and determine whether fibroscan can avoid liver biopsy in patients with CHB.

METHODS

Fibroscan and liver biopsy were performed in 382 consecutive patients with CHB. Biopsies were reviewed by pathologist blinded to the fibroscan value. Discriminant values of liver stiffness measurement (LSM) to reasonably exclude and predict significant fibrosis were calculated from receiver operating characteristic (ROC) curves. The factors affecting LSM independent of fibrosis were assessed.

RESULTS

Three hundred fifty-seven patients were included (mean age 30.1 ± 9.7 years, male : female 17 : 3). There was significant correlation between LSM and histological fibrosis (r = 0.58, P < 0.001). The area under ROC curve of LSM for significant fibrosis (F0-1 vs. F2-4), bridging fibrosis (F0-2 vs. F3-4), and cirrhosis (F0-3 vs. F4) was 0.84 (95% CI: 0.78-0.89), 0.94 (95% CI: 0.89-0.99), and 0.93 (95% CI: 0.85-1.00), respectively. LSM < 6.0 KPa could exclude significant (F ≥ 2) and bridging fibrosis (F ≥ 3) with a negative predictive value (NPV) of 92.4% and 99.5%, respectively. Cut-off of 9 KPa could detect significant (F ≥ 2) and bridging fibrosis (F ≥ 3) with specificity of 95% and 97%, respectively, and had a positive predictive value (PPV) of 84.3% in predicting significant fibrosis. LSM < 6 KPa and > 9 KPa matched with histological fibrosis in 227/250 (91%) patients. Therefore, fibroscan could avoid liver biopsy in 70% (250/357) patients with an accuracy > 90%. Histological fibrosis, ALT > 5 times, and age > 40 years were independent determinants of increased liver stiffness.

CONCLUSIONS

Fibroscan accurately assessed fibrosis and could avoid liver biopsy in more than two-thirds of patients with CHB.

摘要

背景与目的

肝纤维化是慢性乙型肝炎（CHB）预后和治疗的既定决定因素。 Fibroscan 在评估 CHB 纤维化中的作用仍不清楚。本研究旨在将 Fibroscan 与肝活检相关联，并确定 Fibroscan 是否可以避免 CHB 患者进行肝活检。

方法

对 382 例连续 CHB 患者进行 Fibroscan 和肝活检。病理学家对 Fibroscan 值进行了盲法评估。从接收者操作特性（ROC）曲线计算肝硬度测量值（LSM）以合理排除和预测显著纤维化的判别值。评估了独立于纤维化的影响 LSM 的因素。

结果

共纳入 357 例患者（平均年龄 30.1±9.7 岁，男：女 17：3）。LSM 与组织学纤维化之间存在显著相关性（r=0.58，P<0.001）。LSM 对显著纤维化（F0-1 与 F2-4）、桥接纤维化（F0-2 与 F3-4）和肝硬化（F0-3 与 F4）的 ROC 曲线下面积分别为 0.84（95%CI：0.78-0.89）、0.94（95%CI：0.89-0.99）和 0.93（95%CI：0.85-1.00）。LSM<6.0KPa 可排除显著（F≥2）和桥接纤维化（F≥3），阴性预测值（NPV）分别为 92.4%和 99.5%。9 KPa 的截断值可以以 95%和 97%的特异性检测到显著（F≥2）和桥接纤维化（F≥3），预测显著纤维化的阳性预测值（PPV）为 84.3%。LSM<6KPa 和>9KPa 与 227/250（91%）例患者的组织学纤维化相匹配。因此，Fibroscan 可以在 70%（250/357）的 CHB 患者中避免肝活检，准确率>90%。组织学纤维化、ALT>5 倍和年龄>40 岁是肝硬度增加的独立决定因素。