Ianni Filho Daniel, Boin Ilka de Fatima Santana Ferreira, Yamanaka Ademar
Universidade Estadual de Campinas (UNICAMP), Gastrocentro, Campinas, SP, Brasil.
UNICAMP, Gastrocentro, Departamento de Transplante de Fígado, Campinas, SP, Brasil.
Arq Gastroenterol. 2018 Jan-Mar;55(1):2-6. doi: 10.1590/S0004-2803.201800000-02.
Fibrosis are common structural hepatic change in patients with chronic hepatitis. Liver biopsy is the gold standard for determining the extent of liver fibrosis. Considering the technical difficulties and cost, improvements in non-invasive screening tools are greatly needed. Bioimpedance have been shown to be safe to evaluate tissue fibrosis.
To assess the utility of using monofrequential bipolar bioimpedance for the detection of severity of liver fibrosis consistent with chronic viral hepatitis C infections.
One hundred and ten patients were studied prospectively and formed two groups according to the lab tests results for the detection of HCV, ALT and AST: Group 1 Control (n=50 healthy patients with HCV negative and with ALT and AST values within the normal clinical range) and Group 2 Positive (n=60 patients positive for anti-HCV positive) which were biopsied. All patients underwent an examination with an Electro Sensor Complex, bioimpedance technology. To compare the groups 1 and 2, the ROC curves was used to determine the specificity and sensitivity of the bioimpedance to detect liver fibrosis. To identify liver fibrosis severity the Group 2 Positive was subdivided according to the liver biopsy results (Metavir fibrosis score) into: Sub Group 2A (F0-F1 n=25) - patients without or with minimal portal fibrosis and Sub Group 2B (F3-F4 n=20) patients with numerous septa/cirrhosis. A statistical analysis was conducted to analyze the bioimpedance data differences in delta of the conductance.
From the comparison between Groups 1 and 2: 1) The delta value for conductance in the pathway representing the right foot-left hand minus left hand-right foot demonstrated a sensitivity of 85% and a specificity of 78% with a cutoff value ≤5 and P=0.0001. 2) For the comparison between Sub Group 2A (Metavir F0+F1) and Sub Group 2B (Metavir F3+F4), the neural network for the Electro Sensor Complex data demonstrated a sensitivity of 85% and a specificity of 72% with a cutoff probability >50% and P=0.001. AUCROC=0.81.
Bioimpedance technology had good level sensitivity and acceptable specificity for detecting liver fibrosis using delta of the conductance. There is a potential for the use of bioimpedance technology as non-invasive approaches for screening of liver fibrosis.
肝纤维化是慢性肝炎患者常见的肝脏结构改变。肝活检是确定肝纤维化程度的金标准。考虑到技术难度和成本，非常需要改进非侵入性筛查工具。生物电阻抗已被证明可安全用于评估组织纤维化。
评估使用单频双极生物电阻抗检测与慢性丙型病毒性肝炎感染相关的肝纤维化严重程度的效用。
对110例患者进行前瞻性研究，并根据检测HCV、ALT和AST的实验室检查结果分为两组：第1组对照组（n = 50例HCV阴性且ALT和AST值在正常临床范围内的健康患者）和第2组阳性组（n = 60例抗HCV阳性患者），对两组患者均进行肝活检。所有患者均使用电感应综合仪（一种生物电阻抗技术）进行检查。为比较第1组和第2组，采用ROC曲线确定生物电阻抗检测肝纤维化的特异性和敏感性。为确定肝纤维化严重程度，根据肝活检结果（梅塔维纤维化评分）将第2组阳性组再分为：2A亚组（F0 - F1，n = 25）——无门静脉纤维化或仅有轻微门静脉纤维化的患者，以及2B亚组（F3 - F4，n = 20）——有大量间隔/肝硬化的患者。进行统计分析以分析电导差值的生物电阻抗数据差异。
第1组和第2组之间的比较结果如下：1）代表右脚 - 左手减去左手 - 右脚路径的电导差值，其敏感性为85%，特异性为78%，临界值≤5，P = 0.0001。2）对于2A亚组（梅塔维F0 + F1）和2B亚组（梅塔维F3 + F4）之间的比较，电感应综合仪数据的神经网络显示敏感性为85%，特异性为72%，临界概率>50%，P = 0.001。曲线下面积（AUCROC）= 0.81。
生物电阻抗技术在使用电导差值检测肝纤维化方面具有良好的敏感性水平和可接受的特异性。生物电阻抗技术有潜力作为肝纤维化筛查的非侵入性方法。
