XL 探头的超声剪切波成像和瞬时弹性成像技术可准确检测超重或肥胖的慢性肝病患者的纤维化。
Supersonic Shear Imaging and Transient Elastography With the XL Probe Accurately Detect Fibrosis in Overweight or Obese Patients With Chronic Liver Disease.
机构信息
Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida.
Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida.
出版信息
Clin Gastroenterol Hepatol. 2015 Aug;13(8):1502-9.e5. doi: 10.1016/j.cgh.2015.03.014. Epub 2015 Mar 21.
BACKGROUND & AIMS: Assessment of the severity of liver fibrosis is an important step in evaluating patients with chronic liver disease and determining their prognosis. We compared liver stiffness measurements (LSMs) made by supersonic shear imaging (SSI) with those of transient elastography (TE)-XL for their ability to determine the degree of liver fibrosis in overweight or obese patients with chronic liver disease.
METHODS
We performed a prospective study of 258 patients with chronic hepatitis of different etiologies and a body mass index greater than 25, evaluated at the University of Miami from October 2013 to December 2014. Liver stiffness was measured using the TE-XL probe and SSI of the right and left lobes during the same clinic visit, and comparisons were made for fibrosis stage in 124 biopsy-proven patients. In addition, further analysis was performed on a subgroup of 102 chronic hepatitis C virus (HCV)-positive patients for whom biopsy data were available.
RESULTS
Reliable LSMs were obtained from 96.1%, 94.6%, and 72.1% of patients using the TE-XL probe, SSI of the right lobe, and SSI of the left lobe, respectively. TE-XL, SSI of the right lobe, and SSI of the left lobe detected severe fibrosis (fibrosis stages 3-4), with area under the receiver operating characteristic curve (AUROC) values of 0.955, 0.954, and 0.910, respectively, compared with results from histologic analysis for the 124 biopsy-proven patients included in the study; these values were 0.952, 0.949, and 0.917, respectively, for the 102 biopsy-proven patients with HCV infection. TE-XL, SSI of the right lobe, and SSI of the left lobe detected fibrosis stage 4 with AUROC values of 0.920, 0.930, and 0.910, respectively, compared with histologic analysis, in all 124-biopsy proven patients, and with AUROC values of 0.907, 0.914, and 0.887, respectively, in the 102 biopsy-proven patients with chronic HCV infection.
CONCLUSIONS
SSI and the TE-XL probe each accurately quantify liver fibrosis in overweight or obese patients with chronic liver disease, including those with HCV infection, when compared with data obtained from histologic analysis. SSI data obtained from the right lobe and the TE-XL probe can be used to evaluate fibrosis with similar accuracy.
背景与目的
评估肝纤维化的严重程度是评估慢性肝病患者和确定其预后的重要步骤。我们比较了超声剪切波成像（SSI）和瞬时弹性成像（TE）-XL 测量的肝硬度值（LSM）在超重或肥胖的慢性肝病患者中确定肝纤维化程度的能力。
方法
我们进行了一项前瞻性研究，共纳入 258 例不同病因的慢性肝炎和 BMI 大于 25 的患者，这些患者于 2013 年 10 月至 2014 年 12 月在迈阿密大学接受评估。使用 TE-XL 探头和 SSI 同时测量右叶和左叶的肝硬度，对 124 例经活检证实的患者进行纤维化分期比较。此外，对 102 例慢性丙型肝炎病毒（HCV）阳性患者进行了进一步分析，这些患者有活检数据。
结果
使用 TE-XL 探头、右叶 SSI 和左叶 SSI 分别获得了 96.1%、94.6%和 72.1%患者的可靠 LSM。TE-XL、右叶 SSI 和左叶 SSI 检测到严重纤维化（纤维化分期 3-4），在包括研究中的 124 例经活检证实的患者在内的所有患者中，其受试者工作特征曲线下面积（AUROC）值分别为 0.955、0.954 和 0.910，对于 102 例经活检证实的 HCV 感染患者，这些值分别为 0.952、0.949 和 0.917。TE-XL、右叶 SSI 和左叶 SSI 检测到纤维化分期 4 的 AUROC 值分别为 0.920、0.930 和 0.910，与所有 124 例经活检证实的患者的组织学分析结果相比，对于 102 例经活检证实的慢性 HCV 感染患者，这些值分别为 0.907、0.914 和 0.887。
结论
SSI 和 TE-XL 探头在与组织学分析结果比较时，都可以准确地定量评估超重或肥胖的慢性肝病患者，包括 HCV 感染患者的肝纤维化程度。右叶 SSI 数据和 TE-XL 探头都可以以类似的准确性评估纤维化。
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