Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Pathology, Odense University Hospital, Odense, Denmark.
Gastroenterology. 2016 Jan;150(1):123-33. doi: 10.1053/j.gastro.2015.09.040. Epub 2015 Oct 3.
BACKGROUND & AIMS: Alcohol abuse causes half of all deaths from cirrhosis in the West, but few tools are available for noninvasive diagnosis of alcoholic liver disease. We evaluated 2 elastography techniques for diagnosis of alcoholic fibrosis and cirrhosis; liver biopsy with Ishak score and collagen-proportionate area were used as reference.
We performed a prospective study of 199 consecutive patients with ongoing or prior alcohol abuse, but without known liver disease. One group of patients had a high pretest probability of cirrhosis because they were identified at hospital liver clinics (in Southern Denmark). The second, lower-risk group, was recruited from municipal alcohol rehabilitation centers and the Danish national public health portal. All subjects underwent same-day transient elastography (FibroScan), 2-dimensional shear wave elastography (Supersonic Aixplorer), and liver biopsy after an overnight fast.
Transient elastography and 2-dimensional shear wave elastography identified subjects in each group with significant fibrosis (Ishak score ≥3) and cirrhosis (Ishak score ≥5) with high accuracy (area under the curve ≥0.92). There was no difference in diagnostic accuracy between techniques. The cutoff values for optimal identification of significant fibrosis by transient elastography and 2-dimensional shear wave elastography were 9.6 kPa and 10.2 kPa, and for cirrhosis 19.7 kPa and 16.4 kPa. Negative predictive values were high for both groups, but the positive predictive value for cirrhosis was >66% in the high-risk group vs approximately 50% in the low-risk group. Evidence of alcohol-induced damage to cholangiocytes, but not ongoing alcohol abuse, affected liver stiffness. The collagen-proportionate area correlated with Ishak grades and accurately identified individuals with significant fibrosis and cirrhosis.
In a prospective study of individuals at risk for liver fibrosis due to alcohol consumption, we found elastography to be an excellent tool for diagnosing liver fibrosis and for excluding (ruling out rather than ruling in) cirrhosis.
酗酒导致西方半数肝硬化死亡病例，但是针对酒精性肝病，仍缺乏有效的非侵入性诊断工具。我们评估了两种弹性成像技术用于诊断酒精性肝纤维化和肝硬化；肝活检的 Ishak 评分和胶原比例面积作为参考。
我们进行了一项前瞻性研究，纳入 199 例持续或既往酗酒但无已知肝病的患者。一组患者因在丹麦南部的医院肝脏诊所就诊而具有较高的肝硬化先验概率。第二组低风险患者来自市酒精康复中心和丹麦国家公共卫生门户。所有患者均在禁食过夜后同日接受瞬时弹性成像（FibroScan）、二维剪切波弹性成像（Supersonic Aixplorer）和肝活检。
瞬时弹性成像和二维剪切波弹性成像能够准确识别各组中具有显著纤维化（Ishak 评分≥3）和肝硬化（Ishak 评分≥5）的患者（曲线下面积≥0.92）。两种技术的诊断准确性无差异。瞬时弹性成像和二维剪切波弹性成像诊断显著纤维化的最佳截断值分别为 9.6 kPa 和 10.2 kPa，诊断肝硬化的最佳截断值分别为 19.7 kPa 和 16.4 kPa。两种患者组的阴性预测值均较高，但高风险组的肝硬化阳性预测值>66%，而低风险组约为 50%。胆管细胞损伤的酒精性损伤证据，但不是持续的酒精滥用，影响了肝硬度。胶原比例面积与 Ishak 分级相关，能够准确识别出具有显著纤维化和肝硬化的个体。
在一项针对因酒精摄入而有发生肝纤维化风险的个体的前瞻性研究中，我们发现弹性成像技术是诊断肝纤维化和排除（排除而不是纳入）肝硬化的极好工具。
