Taneja Sunil, Borkakoty Amritangsu, Rathi Sahaj, Kumar Vivek, Duseja Ajay, Dhiman Radha K, Gupta Krishan L, Chawla Yogesh
Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Dig Dis Sci. 2017 Nov;62(11):3186-3192. doi: 10.1007/s10620-017-4777-6. Epub 2017 Sep 25.
The patients with end stage renal disease (ESRD) are at greater risk of acquiring chronic hepatitis B or C and subsequently development of liver disease. The aim of the study was to assess liver fibrosis by transient elastography (TE) and look for factors associated with change in liver stiffness measurement (LSM) with one session of hemodialysis (HD).
Consecutive ESRD patients on maintenance hemodialysis (MHD) with suspected liver disease were enrolled. They underwent LSM by TE before and after one session of HD. Bioelectric impedance analysis was done to evaluate the volume status at the time of TE.
Sixty-eight patients with mean age of 40 ± 14 years were included. There was a significant reduction in LSM after HD (18.5 [95% CI 14.8-23.1] vs. 11.2 [95% CI 8.8-13.7] kPa, p < 0.001), with a mean LSM reduction of 7.2 [95% CI 5.25-9.19] kPa. On stratification in two groups by net ultrafiltration during HD (> or < 2.5 liters [L]), change in LSM was substantially higher in patients when total fluid removed was > 2.5 L (8.6 [95% CI 5.7-11.5] vs. 5.1 [95% CI 2.9-7.5], p = 0.05). In 18 patients who underwent liver biopsy, LSM after HD performed better at detecting significant fibrosis, with area under receiver operating characteristics curve 0.71 [95% CI 0.46-0.97], versus 0.64 [95% CI 0.38-0.90], respectively. An LSM value of 12.2 kPa after HD was 71% sensitive and 74% specific for detection of significant fibrosis (≥ F2), while values less than 9 kPa ruled out significant fibrosis with a sensitivity and specificity of 37 and 100%, respectively.
LSM by TE decreases significantly after HD in patients with ESRD on long-term MHD. Hence, TE should be done after HD for accurate assessment of liver fibrosis.
终末期肾病（ESRD）患者感染慢性乙型或丙型肝炎并随后发展为肝病的风险更高。本研究的目的是通过瞬时弹性成像（TE）评估肝纤维化，并寻找与单次血液透析（HD）后肝脏硬度测量值（LSM）变化相关的因素。
纳入接受维持性血液透析（MHD）且疑似患有肝病的连续性ESRD患者。他们在单次HD前后接受了TE测量LSM。进行生物电阻抗分析以评估TE检查时的容量状态。
纳入68例平均年龄为40±14岁的患者。HD后LSM显著降低（18.5[95%CI 14.8 - 23.1]与11.2[95%CI 8.8 - 13.7]kPa，p<0.001），LSM平均降低7.2[95%CI 5.25 - 9.19]kPa。根据HD期间的净超滤量（>或<2.5升[L]）将患者分为两组，当总脱水量>2.5 L时，患者LSM的变化明显更高（8.6[95%CI 5.7 - 11.5]与5.1[95%CI 2.9 - 7.5]，p = 0.05）。在18例接受肝活检的患者中，HD后的LSM在检测显著纤维化方面表现更好，受试者操作特征曲线下面积分别为0.71[95%CI 0.46 - 0.97]和0.64[95%CI 0.38 - ）。HD后LSM值为12.2 kPa时，检测显著纤维化（≥F2）的敏感性为71%，特异性为74%，而小于9 kPa的值排除显著纤维化的敏感性和特异性分别为37%和100%。
长期接受MHD的ESRD患者HD后TE测量的LSM显著降低。因此，为准确评估肝纤维化，应在HD后进行TE检查。
