Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
Gut. 2019 Nov;68(11):2057-2064. doi: 10.1136/gutjnl-2018-317334. Epub 2019 Jan 18.
The latest model of vibration-controlled transient elastography (VCTE) automatically selects M or XL probe according to patients' body built. We aim to test the application of a unified interpretation of VCTE results with probes appropriate for the body mass index (BMI) and hypothesise that this approach is not affected by hepatic steatosis.
We prospectively recruited 496 patients with non-alcoholic fatty liver disease who underwent VCTE by both M and XL probes within 1 week before liver biopsy.
391 (78.8%) and 433 (87.3%) patients had reliable liver stiffness measurement (LSM) (10 successful acquisitions and IQR:median ratio ≤0.30) by M and XL probes, respectively (p<0.001). The area under the receiver operating characteristic curves was similar between the two probes (0.75-0.88 for F2-4, 0.83-0.91 for F4). When used in the same patient, LSM by XL probe was lower than that by M probe (mean difference 2.3 kPa). In contrast, patients with BMI ≥30 kg/m had higher LSM regardless of the probe used. When M and XL probes were used in patients with BMI <30 and ≥30 kg/m, respectively, they yielded nearly identical median LSM at each fibrosis stage and similar diagnostic performance. Severe steatosis did not increase LSM or the rate of false-positive diagnosis by XL probe.
High BMI but not severe steatosis increases LSM. The same LSM cut-offs can be used without further adjustment for steatosis when M and XL probes are used according to the appropriate BMI.
最新一代的控幅振动瞬时弹性成像技术（VCTE）可根据患者的体型自动选择 M 或 XL 探头。我们旨在测试根据体重指数（BMI）统一解释 VCTE 结果的应用，并假设这种方法不受肝脂肪变性的影响。
我们前瞻性招募了 496 名非酒精性脂肪性肝病患者，他们在肝活检前 1 周内接受了 M 和 XL 探头的 VCTE。
M 和 XL 探头分别有 391（78.8%）和 433（87.3%）例患者获得可靠的肝硬度测量值（LSM）（10 次成功采集，IQR：中位数比值≤0.30）（p<0.001）。两种探头的受试者工作特征曲线下面积相似（F2-4 为 0.75-0.88，F4 为 0.83-0.91）。在同一患者中，XL 探头的 LSM 低于 M 探头（平均差值 2.3kPa）。相反，无论使用哪种探头，BMI≥30kg/m2的患者 LSM 均较高。当 M 和 XL 探头分别用于 BMI<30kg/m2和 BMI≥30kg/m2的患者时，它们在每个纤维化阶段的中位 LSM 几乎相同，且具有相似的诊断性能。严重脂肪变性不会增加 XL 探头的 LSM 或假阳性诊断率。
高 BMI 但不是严重脂肪变性会增加 LSM。当根据适当的 BMI 使用 M 和 XL 探头时，无需进一步调整脂肪变性，即可使用相同的 LSM 截断值。
