Krawczyk Marcin, Ligocka Joanna, Ligocki Mariusz, Raszeja-Wyszomirska Joanna, Milkiewicz Małgorzata, Szparecki Grzegorz, Ilczuk Tomasz, Górnicka Barbara, Zieniewicz Krzysztof, Krawczyk Marek, Lammert Frank, Milkiewicz Piotr
a Department of Medicine II , Saarland University Medical Center , Homburg , Germany.
b Laboratory of Metabolic Liver Diseases, Centre for Preclinical Research, Department of General, Transplant and Liver Surgery , Medical University of Warsaw , Warsaw , Poland.
Scand J Gastroenterol. 2017 Dec;52(12):1407-1412. doi: 10.1080/00365521.2017.1370009. Epub 2017 Aug 29.
Previous studies demonstrated a close correlation between transient elastography (TE) and liver histology in chronic liver diseases. Data on the accuracy of TE in primary sclerosing cholangitis (PSC) remains scarce. Here, we investigated the association between TE, serum marker of liver injury and histology of explanted livers in PSC patients.
Thirty patients were prospectively recruited. TE (Fibroscan) and blood sampling were performed during evaluation for liver transplantation (LT); the second blood sampling was performed on the day of LT. Fibrosis of explanted livers according to the seven-point Laennec staging system and liver collagen contents were measured.
TE correlated with Laennec stages of fibrosis (p = .001), collagen contents (p < .001) and with diameter of thickest septa (p = .034) in explanted livers. It also correlated with serum indices of liver injury, namely AST, bilirubin as well as FIB-4 and APRI scores (all p < .05). In a multivariate model, only liver fibrosis, according to either Laennec score (p = .035) or collagen contents (p = .005), was significantly associated with TE. Finally, patients with cirrhosis had increased liver stiffness (p = .002) and the TE cut-off of 13.7 kPa showed the best predictive value (AUC = .90, 95% CI: 0.80-1.00, p < .001) for detecting cirrhosis.
TE correlates with liver fibrosis and markers of liver injury in patients with PSC. However, liver fibrosis seems to be the strongest predictor of liver stiffness assessed with TE. Hence, we postulate that TE is a reliable tool for non-invasive monitoring of PSC.
既往研究表明，瞬时弹性成像（TE）与慢性肝病的肝脏组织学之间存在密切相关性。关于TE在原发性硬化性胆管炎（PSC）中的准确性的数据仍然很少。在此，我们研究了PSC患者中TE、肝损伤血清标志物与移植肝组织学之间的关联。
前瞻性招募了30名患者。在肝移植（LT）评估期间进行TE（Fibroscan）检查和血液采样；第二次血液采样在LT当天进行。根据七点Laennec分期系统测量移植肝的纤维化程度，并测量肝脏胶原含量。
TE与移植肝的Laennec纤维化分期（p = 0.001）、胶原含量（p < 0.001）以及最厚间隔的直径（p = 0.034）相关。它还与肝损伤的血清指标相关，即AST、胆红素以及FIB-4和APRI评分（所有p < 0.05）。在多变量模型中，仅根据Laennec评分（p = 0.035）或胶原含量（p = 0.005）的肝纤维化与TE显著相关。最后，肝硬化患者的肝脏硬度增加（p = 0.002），TE临界值13.7 kPa对检测肝硬化显示出最佳预测价值（AUC = 0.90，95% CI：0.80 - 1.00，p < 0.001）。
TE与PSC患者的肝纤维化和肝损伤标志物相关。然而，肝纤维化似乎是通过TE评估的肝脏硬度的最强预测指标。因此，我们推测TE是PSC无创监测的可靠工具。
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