Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France; INSERM U1053, Université Bordeaux Segalen, Bordeaux, France.
Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France.
J Hepatol. 2014 May;60(5):1026-31. doi: 10.1016/j.jhep.2013.12.018. Epub 2013 Dec 28.
BACKGROUND & AIMS: Controlled attenuation parameter (CAP) evaluated with transient elastography (FibroScan®) is a recent method for non-invasive assessment of steatosis. Its usefulness in clinical practice is unknown. We prospectively investigated the determinants of CAP failure and the relationships between CAP and clinical or biological parameters in a large cohort of consecutive patients.
All CAP examinations performed in adult patients with suspected chronic liver disease were included. CAP failure was defined as zero valid shot. The following factors were analyzed for their influence on CAP value and the relationships between CAP and clinico-biological parameters: age, gender, body mass index, waist circumference, hypertension, diabetes, metabolic syndrome, alcohol use, liver stiffness measurement, indication, and different biological parameters.
CAP failure occurred in 7.7% of 5323 examinations. By multivariate analysis, factors independently associated with CAP measurement failure were female gender, BMI, and metabolic syndrome. By multivariate analysis, factors significantly associated with elevated CAP were BMI [25-30]kg/m(2), BMI >30kg/m(2), metabolic syndrome, alcohol >14 drink/week and liver stiffness >6kPa. CAP increased with the number of parameters of metabolic syndrome, BMI, waist circumference, the presence of diabetes or hypertension, and the cause of the disease. In the 440 patients with liver biopsy, for the diagnosis of steatosis >10%, steatosis >33%, and steatosis >66%, AUROCs of CAP were 0.79 (95% CI 0.74-0.84, p<0.001), 0.84 (95% CI 0.80-0.88, p<0.001), 0.84 (95% CI 0.80-0.88, p<0.001), respectively.
CAP provides an immediate assessment of steatosis simultaneously with liver stiffness measurement. The strong association of CAP with the metabolic syndrome and alcohol use could be of interest for the follow-up of NAFLD or alcoholic patients.
瞬时弹性成像（FibroScan®）检测的受控衰减参数（CAP）是一种新的非侵入性评估脂肪变性的方法。其在临床实践中的应用尚不清楚。我们前瞻性地研究了 CAP 检测失败的决定因素，以及 CAP 与大样本连续患者的临床或生物学参数之间的关系。
纳入所有怀疑患有慢性肝病的成年患者的 CAP 检测。将 CAP 检测失败定义为零个有效检测。分析了以下因素对 CAP 值的影响以及 CAP 与临床生物学参数之间的关系：年龄、性别、体重指数、腰围、高血压、糖尿病、代谢综合征、酒精使用、肝硬度测量、检测指征和不同的生物学参数。
5323 次检测中有 7.7%出现 CAP 检测失败。多变量分析显示，与 CAP 测量失败独立相关的因素是女性、BMI 和代谢综合征。多变量分析显示，与 CAP 升高显著相关的因素是 BMI [25-30]kg/m²、BMI>30kg/m²、代谢综合征、每周饮酒>14 杯和肝硬度>6kPa。CAP 随代谢综合征参数、BMI、腰围、糖尿病或高血压的存在以及疾病的病因数量的增加而增加。在 440 例肝活检患者中，对于脂肪变性>10%、脂肪变性>33%和脂肪变性>66%的诊断，CAP 的 AUROC 分别为 0.79（95%CI 0.74-0.84，p<0.001）、0.84（95%CI 0.80-0.88，p<0.001）、0.84（95%CI 0.80-0.88，p<0.001）。
CAP 可与肝硬度同时提供对脂肪变性的即时评估。CAP 与代谢综合征和酒精使用的强烈关联可能对非酒精性脂肪性肝病或酒精性肝病患者的随访具有重要意义。
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