使用瞬时弹性成像和慧指数对肝纤维化进行无创评估可预测慢性乙型肝炎患者的生存率。

Noninvasive assessments of liver fibrosis with transient elastography and Hui index predict survival in patients with chronic hepatitis B.

作者信息

Wong Grace Lai-Hung, Chan Henry Lik-Yuen, Yu Zhuo, Wong Catherine Ka-Yan, Leung Calvin, Ho Patricia Po-Lai, Chan Candace Yim, Chung Vivian Chi-Yee, Chan Zhan Cham-Yan, Tse Yee-Kit, Chim Angel Mei-Ling, Lau Tina Kit-Ting, Chan Hoi-Yun, Tse Chi-Hang, Wong Vincent Wai-Sun

机构信息

Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China.

出版信息

J Gastroenterol Hepatol. 2015 Mar;30(3):582-90. doi: 10.1111/jgh.12779.

DOI:10.1111/jgh.12779

PMID:25252074

Abstract

BACKGROUND AND AIMS

The prognostic role of noninvasive assessments of liver fibrosis has been evolving. Our aim was to investigate the prognostic value of liver stiffness measurement (LSM) with transient elastography and serum-based Hui index to predict hepatic events and deaths in chronic hepatitis B (CHB) patients.

METHODS

The main prospective cohort included 1555 consecutive CHB patients referred for transient elastography examination; a subgroup of 980 patients underwent follow-up assessments at least 3 years later formed the serial cohort. Cox proportional hazard model was performed to determine the relationship of LSM, Hui index and other clinical variables with hepatic events and deaths.

RESULTS

During a mean follow-up of 69 ± 9 months, 119 patients (7.6%) developed hepatic events or deaths. Hepatic event-free survival was significantly decreased with increasing stages of LSM and Hui index. The 5-year cumulative probability of hepatic event-free survival of patients of Stage 1-7 of LSM were 99.3%, 98.8%, 95.7%, 90.9%, 89.6%, 74.6%, and 50.0%, respectively; that of Stage 1 to 3 of Hui index were 98.2%, 93.1%, and 77.5%, respectively. Independent predictors of hepatic event-free survival were age, baseline LSM, and follow-up Hui index. Serum ALT and body mass index affected the accuracy of prediction by LSM. Patients remained early stages of LSM or Hui index at follow-up visit had better survival compared to those remained at late stages.

CONCLUSION

Baseline and change in noninvasive parameters of liver fibrosis, LSM and Hui index, are accurate to predict hepatic event-free survival in CHB patients.

摘要

背景与目的

肝纤维化非侵入性评估的预后作用一直在不断演变。我们的目的是研究通过瞬时弹性成像测量肝脏硬度（LSM）和基于血清的惠氏指数预测慢性乙型肝炎（CHB）患者肝脏事件和死亡的预后价值。

方法

主要前瞻性队列包括1555例连续接受瞬时弹性成像检查的CHB患者；980例患者的亚组在至少3年后接受随访评估，形成了系列队列。采用Cox比例风险模型确定LSM、惠氏指数和其他临床变量与肝脏事件和死亡之间的关系。

结果

在平均69±9个月的随访期间，119例患者（7.6%）发生了肝脏事件或死亡。随着LSM和惠氏指数阶段的增加，无肝脏事件生存率显著降低。LSM 1-7期患者5年无肝脏事件生存累积概率分别为99.3%、98.8%、95.7%、90.9%、89.6%、74.6%和50.0%；惠氏指数1-3期患者分别为98.2%、93.1%和77.5%。无肝脏事件生存的独立预测因素为年龄、基线LSM和随访惠氏指数。血清ALT和体重指数影响LSM预测的准确性。随访时LSM或惠氏指数仍处于早期阶段的患者比仍处于晚期阶段的患者生存率更高。