Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
J Gastroenterol Hepatol. 2019 Sep;34(9):1611-1619. doi: 10.1111/jgh.14629. Epub 2019 Mar 10.
Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure-function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the C-methacetin Liver MAximum capacity (LiMAx) test and tissue-structure related stiffness by 2D time-harmonic elastography for the assessment of liver disease progression.
LiMAx test and time-harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue.
LiMAx values correlated negatively with liver stiffness (r = -0.747), aminotransferase to platelet ratio index (r = -0.604), and fibrosis 4 (r = -0.573). Median (interquartile range) LiMAx values decreased with fibrosis progression from 395 μg/kg/h (371-460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126-309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52-1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54-1.67 m/s]) to severe fibrosis (1.85 m/s [1.76-1.92 m/s]).
Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.
准确评估肝脏的结构和功能特征可以改善慢性肝病患者的诊断和临床管理。然而，慢性肝病进展过程中的结构-功能关系仍不清楚。本研究的目的是通过 C-美沙酮肝最大容量（LiMAx）试验联合测量肝脏功能和二维时谐波弹性成像测量组织结构相关硬度，以评估肝脏疾病的进展。
对慢性肝病患者（n=75）和健康对照者（n=22）进行 LiMAx 试验和时谐波弹性成像，并计算纤维化 4 指数和天冬氨酸氨基转移酶血小板比值指数的血清学评分。在 47 例接受手术的患者中，通过对切除的肝组织进行组织学检查对纤维化进行分级。
LiMAx 值与肝脏硬度（r=-0.747）、天冬氨酸氨基转移酶血小板比值指数（r=-0.604）和纤维化 4 指数（r=-0.573）呈负相关。LiMAx 值中位数（四分位距）随着纤维化进展而降低，从无纤维化患者的 395μg/kg/h（371-460μg/kg/h）到严重纤维化患者的 173μg/kg/h（126-309μg/kg/h）。肝脏硬度中位数随纤维化分期逐渐升高，从无纤维化（1.56m/s[1.52-1.63m/s]）到中度纤维化（1.60m/s[1.54-1.67m/s]）再到严重纤维化（1.85m/s[1.76-1.92m/s]）。
我们的研究结果表明，进展性肝病导致的肝脏结构变化，反映为组织硬度增加，与肝脏代谢功能下降相关，反映为肝脏代谢能力下降。
