Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Duke-NUS Medical School, Singapore.
Singapore Med J. 2019 Oct;60(10):532-537. doi: 10.11622/smedj.2018156. Epub 2018 Dec 17.
Despite the widespread use of transient elastography for non-invasive assessment of liver fibrosis, the optimal cut-off liver stiffness measurement (LSM) values remain unclear. This study aimed to validate the optimal cut-off LSM values for significant fibrosis and cirrhosis in patients with chronic liver disease (CLD).
Prospective multicentre data of CLD patients who underwent paired liver biopsy and LSM was analysed to determine the optimal cut-off LSM values for predicting significant fibrosis (METAVIR F ≥ 2) and cirrhosis (METAVIR F4). A high-quality cohort was selected by excluding those with failed LSM and invalid LSM readings.
Of the 481 patients recruited, 322 fulfilled the pre-defined quality criteria. CLD aetiology was chronic hepatitis B (CHB) in 49%, non-alcoholic steatohepatitis (NASH) in 16% and chronic hepatitis C (CHC) in 12%. Area under the receiver operating characteristic curve for LSM was 0.775 (95% confidence interval [CI] 0.724-0.826) for significant fibrosis and 0.810 (95% CI 0.738-0.882) for cirrhosis. Optimal cut-off LSM values were 9 kPa for significant fibrosis and 13 kPa for cirrhosis in the general cohort. Optimal cut-off LSM values were 9 kPa for significant fibrosis and 12 kPa for cirrhosis for both CHB and CHC, while the corresponding values for NASH were 11 kPa and 15 kPa.
Optimal cut-off LSM values should be selected based on disease aetiology. In Singapore, the optimal cut-off LSM values for CHB and CHC are 9 kPa for significant fibrosis and 12 kPa for cirrhosis. Optimal cut-off values for NASH require further validation.
尽管瞬时弹性成像已广泛用于非侵入性评估肝纤维化，但最佳的肝硬度测量（LSM）截断值仍不明确。本研究旨在验证慢性肝病（CLD）患者中用于预测显著纤维化（METAVIR F≥2）和肝硬化（METAVIR F4）的最佳 LSM 截断值。对接受肝活检和 LSM 检测的 CLD 患者的前瞻性多中心数据进行分析，以确定预测显著纤维化（METAVIR F≥2）和肝硬化（METAVIR F4）的最佳 LSM 截断值。通过排除 LSM 检测失败和无效的患者，选择高质量队列。
在纳入的 481 例患者中，有 322 例符合预先定义的质量标准。CLD 的病因包括慢性乙型肝炎（CHB）占 49%、非酒精性脂肪性肝炎（NASH）占 16%和慢性丙型肝炎（CHC）占 12%。LSM 对显著纤维化的受试者工作特征曲线下面积为 0.775（95%置信区间 [CI]：0.724-0.826），对肝硬化的面积为 0.810（95%CI：0.738-0.882）。在一般队列中，LSM 用于显著纤维化的最佳截断值为 9kPa，用于肝硬化的最佳截断值为 13kPa。对于 CHB 和 CHC，LSM 用于显著纤维化的最佳截断值为 9kPa，用于肝硬化的最佳截断值为 12kPa，而对于 NASH，相应的最佳截断值为 11kPa 和 15kPa。
最佳的 LSM 截断值应根据疾病病因选择。在新加坡，CHB 和 CHC 的最佳 LSM 截断值用于显著纤维化的为 9kPa，用于肝硬化的为 12kPa。NASH 的最佳截断值需要进一步验证。
