Schulman Allison R, Lin Ming V, Rutherford Anna, Chan Walter W, Ryou Marvin
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.
Clin Endosc. 2018 Mar;51(2):181-185. doi: 10.5946/ce.2017.095. Epub 2018 Mar 23.
BACKGROUND/AIMS: Liver biopsy has traditionally been used for determining the degree of fibrosis, however there are several limitations. Endoscopic ultrasound (EUS) real-time elastography (RTE) is a novel technology that uses image enhancement to display differences in tissue compressibility. We sought to assess whether liver fibrosis index (LFI) can distinguish normal, fatty, and cirrhotic liver tissue.
A total of 50 patients undergoing EUS were prospectively enrolled. RTE of the liver was performed to synthesize the LFI in each patient. Univariate and multivariable analyses were performed. Chi-square and -tests were performed for categorical and continuous variables, respectively. A -value of <0.05 was considered significant.
Abdominal imaging prior to endoscopic evaluation suggested normal tissue, fatty liver, and cirrhosis in 26, 16, and 8 patients, respectively. Patients with cirrhosis had significantly increased mean LFI compared to the fatty liver (3.2 vs. 1.7, <0.001) and normal (3.2 vs. 0.8, <0.001) groups. The fatty liver group showed significantly increased LFI compared to the normal group (3.8 vs. 1.4, <0.001). Multivariable regression analysis suggested that LFI was an independent predictor of group features (<0.001).
LFI computed from RTE images significantly correlates with abdominal imaging and can distinguish normal, fatty, and cirrhotic-appearing livers; therefore, LFI may play an important role in patients with chronic liver disease.
背景/目的：肝活检传统上用于确定纤维化程度，然而存在一些局限性。内镜超声（EUS）实时弹性成像（RTE）是一种利用图像增强来显示组织可压缩性差异的新技术。我们试图评估肝纤维化指数（LFI）是否能够区分正常、脂肪肝和肝硬化肝组织。
前瞻性纳入了50例接受EUS检查的患者。对肝脏进行RTE检查以计算每位患者的LFI。进行单变量和多变量分析。分别对分类变量和连续变量进行卡方检验和t检验。P值<0.05被认为具有统计学意义。
内镜评估前的腹部影像学检查显示，分别有26例、16例和8例患者为正常组织、脂肪肝和肝硬化。与脂肪肝组（3.2对1.7，P<0.001）和正常组（3.2对0.8，P<0.001）相比，肝硬化患者的平均LFI显著升高。与正常组相比，脂肪肝组的LFI显著升高（3.8对1.4，P<0.001）。多变量回归分析表明，LFI是分组特征的独立预测因子（P<0.001）。
通过RTE图像计算出的LFI与腹部影像学检查显著相关，能够区分正常、脂肪肝和疑似肝硬化的肝脏；因此，LFI可能在慢性肝病患者中发挥重要作用。
