瞬时弹性成像- FibroScan®、声辐射力脉冲（ARFI）成像、增强型肝脏纤维化（ELF）检测、APRI 和 FIB-4 指数与慢性丙型肝炎患者肝活检的比较。
Accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C.
机构信息
Divisao de Gastroenterologia e Hepatologia Clinica, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Divisao de Gastroenterologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR.
出版信息
Clinics (Sao Paulo). 2017 Oct;72(9):516-525. doi: 10.6061/clinics/2017(09)01.
OBJECTIVES
Although liver biopsy is the gold standard for determining the degree of liver fibrosis, issues regarding its invasiveness and the small amount of liver tissue evaluated can limit its applicability and interpretation in clinical practice. Non-invasive evaluation methods for liver fibrosis can address some of these limitations. The aim of this study was to evaluate the accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI), enhanced liver fibrosis (ELF), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index compared with liver biopsy in hepatitis C.
METHODS
We evaluated chronic hepatitis C patients who were followed at the Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology of University of São Paulo School of Medicine, São Paulo, Brazil, and who underwent liver biopsy. The accuracy of each method was determined by a receiver operating characteristic (ROC) curve analysis, and fibrosis was classified as significant fibrosis (≥F2), advanced fibrosis (≥F3), or cirrhosis (F4). The Obuchowski method was also used to determine the diagnostic accuracy of each method at the various stages of fibrosis. In total, 107 FibroScan®, 51 ARFI, 68 ELF, 106 APRI, and 106 FIB-4 analyses were performed.
RESULTS
A total of 107 patients were included in the study. The areas under the ROC curve (AUROCs) according to fibrosis degree were as follows: significant fibrosis (≥F2): FibroScan®: 0.83, FIB-4: 0.76, ELF: 0.70, APRI: 0.69, and ARFI: 0.67; advanced fibrosis (≥F3): FibroScan®: 0.85, ELF: 0.82, FIB-4: 0.77, ARFI: 0.74, and APRI: 0.71; and cirrhosis (F4): APRI: 1, FIB-4: 1, FibroScan®: 0.99, ARFI: 0.96, and ELF: 0.94. The accuracies of transient elastography, ARFI, ELF, APRI and FIB-4 determined by the Obuchowski method were F0-F1: 0.81, 0.78, 0.44, 0.72 and 0.67, respectively; F1-F2: 0.73, 0.53, 0.62, 0.60, and 0.68, respectively; F2-F3: 0.70, 0.64, 0.77, 0.60, and 0.67, respectively; and F3-F4: 0.98, 0.96, 0.82, 1, and 1, respectively.
CONCLUSION
Transient elastography remained the most effective method for evaluating all degrees of fibrosis. The accuracy of all methodologies was best at F4.
目的
虽然肝活检是确定肝纤维化程度的金标准，但由于其侵袭性和评估的肝组织量较小，在临床实践中其应用和解释受到限制。肝纤维化的非侵入性评估方法可以解决其中的一些局限性。本研究的目的是评估瞬时弹性成像- FibroScan ® 、声辐射力脉冲（ARFI）、增强肝纤维化（ELF）、天门冬氨酸氨基转移酶-血小板比值指数（APRI）和纤维化 4 指数（FIB-4）在丙型肝炎中的肝活检准确性。
方法
我们评估了在巴西圣保罗大学医学院胃肠病学系临床胃肠病学分部接受随访的慢性丙型肝炎患者，并进行了肝活检。通过接收者操作特征（ROC）曲线分析确定每种方法的准确性，并将纤维化分为显著纤维化（≥F2）、进展性纤维化（≥F3）或肝硬化（F4）。还使用 Obuchowski 方法来确定每种方法在不同纤维化阶段的诊断准确性。共进行了 107 次 FibroScan ® 、51 次 ARFI、68 次 ELF、106 次 APRI 和 106 次 FIB-4 分析。
结果
共有 107 例患者纳入研究。根据纤维化程度的 ROC 曲线下面积（AUROCs）如下：显著纤维化（≥F2）：FibroScan ® ：0.83、FIB-4：0.76、ELF：0.70、APRI：0.69 和 ARFI：0.67；进展性纤维化（≥F3）：FibroScan ® ：0.85、ELF：0.82、FIB-4：0.77、ARFI：0.74 和 APRI：0.71；肝硬化（F4）：APRI：1、FIB-4：1、FibroScan ® ：0.99、ARFI：0.96 和 ELF：0.94。Obuchowski 方法确定的瞬时弹性成像、ARFI、ELF、APRI 和 FIB-4 的准确性为 F0-F1：0.81、0.78、0.44、0.72 和 0.67；F1-F2：0.73、0.53、0.62、0.60 和 0.68；F2-F3：0.70、0.64、0.77、0.60 和 0.67；F3-F4：0.98、0.96、0.82、1 和 1。
结论
瞬时弹性成像仍然是评估所有纤维化程度最有效的方法。所有方法的准确性在 F4 时最佳。
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