Jia Jidong, Hou Jinlin, Ding Huiguo, Chen Guofeng, Xie Qing, Wang Yuming, Zeng Minde, Zhao Jingmin, Wang Tailing, Hu Xiqi, Schuppan D
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis & National Clinical Research Center of Digestive Diseases, Beijing, China.
J Gastroenterol Hepatol. 2015 Apr;30(4):756-62. doi: 10.1111/jgh.12840.
Liver stiffness measurement (LSM) using transient elastography (FibroScan) is a useful tool to assess fibrosis in various chronic liver diseases. However, studies were mainly performed in Western countries and largely focused on chronic hepatitis C (CHC). We therefore carried out a multicenter study to validate the accuracy of LSM in the assessment of liver fibrosis in a large cohort of Chinese patients with chronic hepatitis B (CHB).
We compared LSM results to histological staging and serum fibrosis markers (five direct markers, APRI and FIB-4) using Spearman correlation analysis and area under receiver operating characteristic (ROC) curves (AUROCs).
Four hundred sixty-nine patients were enrolled and eligible for statistical analysis. LSM in F0 to F4 was 5.5 ± 1.7, 5.8 ± 2.2, 7.6 ± 3.4, 14.5 ± 10.8, and 22.3 ± 13.6 kPa, respectively (correlation with fibrosis stage r = 0.522, P < 0.001). AUROC for LSM to correctly allocate patients to histological fibrosis stage ≥ F2, ≥ F3, and F4 was 0.82, 0.88, and 0.90, respectively. LSM outperformed serum fibrosis markers for detection of fibrosis F ≥ 2 and F4. Patients with ALT levels 1-5x and > 5x the upper limit of normal values had significantly higher stiffness values than stage-matched patients with normal alanine aminotransferase.
Transient elastography is a reliable noninvasive technique to predict significant liver fibrosis in Chinese patients with CHB, being superior to current biomarker panels. However, enhanced inflammatory activity can lead to elevated stiffness values unrelated to histological fibrosis stage.
使用瞬时弹性成像（FibroScan）进行肝脏硬度测量（LSM）是评估各种慢性肝病纤维化的有用工具。然而，相关研究主要在西方国家开展，且很大程度上聚焦于慢性丙型肝炎（CHC）。因此，我们开展了一项多中心研究，以验证LSM在中国慢性乙型肝炎（CHB）患者大样本队列中评估肝纤维化的准确性。
我们使用Spearman相关分析以及受试者操作特征曲线（ROC）下面积（AUROCs），将LSM结果与组织学分期和血清纤维化标志物（五种直接标志物、APRI和FIB-4）进行比较。
469例患者入组并符合统计分析条件。F0至F4期的LSM分别为5.5±1.7、5.8±2.2、7.6±3.4、14.5±10.8和22.3±13.6 kPa（与纤维化分期的相关性r = 0.522，P < 0.001）。LSM将患者正确分配至组织学纤维化分期≥F2、≥F3和F4的AUROC分别为0.82、0.88和0.90。在检测纤维化F≥2和F4方面，LSM优于血清纤维化标志物。丙氨酸氨基转移酶（ALT）水平为正常上限1 - 5倍和>5倍的患者，其硬度值显著高于丙氨酸氨基转移酶正常的分期匹配患者。
瞬时弹性成像是预测中国CHB患者显著肝纤维化的可靠无创技术，优于当前的生物标志物组合。然而，增强的炎症活动可导致与组织学纤维化分期无关的硬度值升高。
