Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy; Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.
Programma di Ecografia Interventistica Diagnostica e Terapeutica, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy.
Clin Gastroenterol Hepatol. 2019 Feb;17(3):510-517.e3. doi: 10.1016/j.cgh.2018.06.027. Epub 2018 Jun 20.
BACKGROUND & AIMS: Elastography point quantification (ElastPQ) is a non-invasive method for assessing liver fibrosis based on liver stiffness. We evaluated the accuracy of ElastPQ for the staging of liver fibrosis in patients with chronic liver disease (CLD) compared with aspartate transaminase to platelet ratio index, fibrosis-4 index, and transient elastography (TE), using liver biopsy as reference standard.
We performed a retrospective study of 406 patients with CLD of any etiology who underwent liver biopsy analysis from September 2012 through June 2017 at a clinic in Bologna, Italy. We obtained liver stiffness measurements, made by ElastPQ and TE, for 361 patients. Liver fibrosis stage was assessed by the METAVIR scoring system. Areas under the receiver operating characteristic curve (AUROC) were used to assess the diagnostic performance of ElastPQ.
ElastPQ values correlated with histologic detection of fibrosis (r = 0.718; P < .001). The AUROC values were 0.856 for detection of significant fibrosis (F≥2), 0.951 for advanced fibrosis (F≥3), and 0.965 for cirrhosis. The best cut-off values identified for classifying patients with F≥2, F≥3, or cirrhosis were 6.0 kPa, 6.2 kPa, and 9.5 kPa, respectively: these were lower than those for TE. Comparison of ElastPQ with TE data resulted in superimposable diagnostic accuracy of both methods for each stage of liver fibrosis. Both elastography techniques performed better than aspartate transaminase to platelet ratio index or fibrosis-4 index scores (P < .05 for all AUROC comparisons).
ElastPQ has good to excellent performance for the non-invasive staging of liver fibrosis in patients with CLD. ElastPQ identified patients with fibrosis or cirrhosis with levels of accuracy that were not inferior to those of TE, and outperformed serum fibrosis indexes in identifying each stage of liver fibrosis.
基于肝硬度的弹性成像点量化（ElastPQ）是一种非侵入性方法，用于评估肝纤维化的分期。我们评估了 ElastPQ 在评估任何病因的慢性肝病（CLD）患者肝纤维化分期方面的准确性，与天冬氨酸转氨酶与血小板比值指数、纤维化-4 指数和瞬时弹性成像（TE）相比，以肝活检为参考标准。
我们对 2012 年 9 月至 2017 年 6 月在意大利博洛尼亚的一家诊所接受肝活检分析的 406 例 CLD 患者进行了回顾性研究。我们获得了 361 例患者的 ElastPQ 和 TE 测量的肝硬度值。肝纤维化分期采用 METAVIR 评分系统评估。接受者操作特征曲线下面积（AUROC）用于评估 ElastPQ 的诊断性能。
ElastPQ 值与组织学检测到的纤维化相关（r=0.718；P<0.001）。AUROC 值为 0.856 用于检测显著纤维化（F≥2），0.951 用于检测晚期纤维化（F≥3），0.965 用于检测肝硬化。为将患者分为 F≥2、F≥3 或肝硬化，最佳截断值分别为 6.0 kPa、6.2 kPa 和 9.5 kPa：这些值低于 TE 的值。ElastPQ 与 TE 数据的比较结果表明，两种方法在肝纤维化的每个阶段均具有相似的诊断准确性。两种弹性成像技术的性能均优于天冬氨酸转氨酶与血小板比值指数或纤维化-4 指数评分（所有 AUROC 比较的 P<0.05）。
ElastPQ 对 CLD 患者肝纤维化的非侵入性分期具有良好至优异的性能。ElastPQ 确定纤维化或肝硬化患者的准确性水平与 TE 相当，并且在确定肝纤维化的每个阶段方面优于血清纤维化指数。
