利用 Fibroscan®进行瞬时弹性成像的可行性和可靠性：2335 次检查的实践审核。
The feasibility and reliability of transient elastography using Fibroscan®: a practice audit of 2335 examinations.
出版信息
Can J Gastroenterol Hepatol. 2014 Mar;28(3):143-9. doi: 10.1155/2014/952684.
BACKGROUND
Liver stiffness measurement (LSM) using transient elastography is widely used in the management of patients with chronic liver disease.
OBJECTIVES
To examine the feasibility and reliability of LSM, and to identify patient and operator characteristics predictive of poorly reliable results.
METHODS
The present retrospective study investigated the frequency and determinants of poorly reliable LSM (interquartile range [IQR]⁄median LSM [IQR⁄M] >30% with median liver stiffness ≥7.1 kPa) using the FibroScan (Echosens, France) over a three-year period. Two experienced operators performed all LSMs. Multiple logistic regression analyses examined potential predictors of poorly reliable LSMs including age, sex, liver disease, the operator, operator experience (<500 versus ≥500 scans), FibroScan probe (M versus XL), comorbidities and liver stiffness. In a subset of patients, medical records were reviewed to identify obesity (body mass index ≥30 kg⁄m2).
RESULTS
Between July 2008 and June 2011, 2335 patients with liver disease underwent LSM (86% using the M probe). LSM failure (no valid measurements) occurred in 1.6% (n=37) and was more common using the XL than the M probe (3.4% versus 1.3%; P=0.01). Excluding LSM failures, poorly reliable LSMs were observed in 4.9% (n=113) of patients. Independent predictors of poorly reliable LSM included older age (OR 1.03 [95% CI 1.01 to 1.05]), chronic pulmonary disease (OR 1.58 [95% CI 1.05 to 2.37), coagulopathy (OR 2.22 [95% CI 1.31 to 3.76) and higher liver stiffness (OR per kPa 1.03 [95% CI 1.02 to 1.05]), including presumed cirrhosis (stiffness ≥12.5 kPa; OR 5.24 [95% CI 3.49 to 7.89]). Sex, diabetes, the underlying liver disease and FibroScan probe were not significant. Although reliability varied according to operator (P<0.0005), operator experience was not significant. In a subanalysis including 434 patients with body mass index data, obesity influenced the rate of poorly reliable results (OR 2.93 [95% CI 0.95 to 9.05]; P=0.06).
CONCLUSIONS
FibroScan failure and poorly reliable LSM are uncommon. The most important determinants of poorly reliable results are older age, obesity, higher liver stiffness and the operator, the latter emphasizing the need for adequate training.
背景
瞬时弹性成像技术（TE）的肝脏硬度测量（LSM）在慢性肝病患者的管理中得到广泛应用。
目的
研究 LSM 的可行性和可靠性，并确定预测结果不可靠的患者和操作者特征。
方法
本回顾性研究使用 FibroScan（Echosens，法国）在三年内调查了 LSM 结果不可靠的频率和决定因素（四分位间距 [IQR]⁄中位数 LSM [IQR⁄M] >30%，中位数肝脏硬度≥7.1 kPa）。两名经验丰富的操作人员进行了所有 LSM 检测。多变量逻辑回归分析检查了 LSM 结果不可靠的潜在预测因素，包括年龄、性别、肝脏疾病、操作者、操作者经验（<500 次与≥500 次扫描）、FibroScan 探头（M 与 XL）、合并症和肝脏硬度。在部分患者中，回顾病历以确定肥胖症（体重指数≥30 kg⁄m2）。
结果
2008 年 7 月至 2011 年 6 月期间，86%的患者（n=2335）使用 M 探头进行 LSM 检测。LSM 失败（无有效测量）发生率为 1.6%（n=37），XL 探头的发生率高于 M 探头（3.4%比 1.3%；P=0.01）。排除 LSM 失败后，113 例（4.9%）患者的 LSM 结果不可靠。不可靠 LSM 的独立预测因素包括年龄较大（OR 1.03 [95%CI 1.01 至 1.05]）、慢性肺部疾病（OR 1.58 [95%CI 1.05 至 2.37]）、凝血障碍（OR 2.22 [95%CI 1.31 至 3.76]）和较高的肝脏硬度（每千帕 OR 1.03 [95%CI 1.02 至 1.05]），包括疑似肝硬化（硬度≥12.5 kPa；OR 5.24 [95%CI 3.49 至 7.89]）。性别、糖尿病、基础肝脏疾病和 FibroScan 探头均无显著意义。尽管可靠性因操作者而异（P<0.0005），但操作者经验并无显著意义。在包括 434 例体重指数数据的亚分析中，肥胖影响了结果不可靠的发生率（OR 2.93 [95%CI 0.95 至 9.05]；P=0.06）。
结论
FibroScan 失败和不可靠的 LSM 并不常见。不可靠结果的最重要决定因素是年龄较大、肥胖、较高的肝脏硬度和操作者，后者强调了充分培训的必要性。
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