经超声内镜引导的双侧肝脏活检可提高非酒精性脂肪性肝炎患者疾病严重程度的评估。
Bi-lobar liver biopsy via EUS enhances the assessment of disease severity in patients with non-alcoholic steatohepatitis.
机构信息
Department of Gastroenterology and Hepatology, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 18702, USA.
Department of Pathology, Geisinger Medical Center, Danville, PA, USA.
出版信息
Hepatol Int. 2019 May;13(3):323-329. doi: 10.1007/s12072-019-09945-4. Epub 2019 Apr 16.
BACKGROUND
In patients with non-alcoholic fatty liver disease (NAFLD), all-cause mortality increases with fibrosis stage. Liver biopsy (LB), performed predominantly in the right lobe, assesses fibrosis, however, right lobe LB may not be sufficient due to histological variation in different lobes. Endoscopic ultrasound (EUS) allows for biopsy of right and left liver lobes in the same setting.
METHODS
This retrospective study assessed for histologic variability amongst left and right liver lobe (L:R) specimens obtained via EUS at a tertiary care center. Between January 2012 and December 2015, 38 NAFLD patients underwent LB, in whom both lobes were sampled.
RESULTS
L:R agreement was near-perfect for steatosis (κ = 0.816, 95% CI 0.674, 0.958), good for ballooning (κ = 0.740, 95% CI 0.565, 0.916) and moderate for lobular inflammation (κ = 0.401 95% CI 0.110, 0.692) and fibrosis (κ = 0.473, 95% CI 0.275, 0.672). Intra-observer variability assessed by blinded repeat slide readings was almost perfect for fibrosis and steatosis (κ = 1, 95% CI 1, 1 and κ = 0.939, 95% CI 0.881, 0.997 respectively) and substantial for lobular inflammation (κ = 0.725, 95% CI 0.584, 0.866). Only right lobe assessment underestimated fibrosis in 21%, inflammation in 13%, and steatosis and ballooning in 8% cases.
CONCLUSIONS
These data indicate that in NAFLD, due to regional variation, EUS-guided bi-lobar LB improves assessment of disease activity and fibrosis.
背景
在非酒精性脂肪性肝病（NAFLD）患者中，全因死亡率随纤维化分期而增加。肝活检（LB）主要在右叶进行，可评估纤维化，但由于不同肝叶的组织学变化，右叶 LB 可能不够充分。内镜超声（EUS）允许在同一部位对右肝和左肝进行活检。
方法
本回顾性研究评估了在一家三级护理中心进行的 EUS 引导的左右肝叶（L：R）标本的组织学变异性。在 2012 年 1 月至 2015 年 12 月期间，38 名 NAFLD 患者接受了 LB，其中两个肝叶均进行了取样。
结果
L：R 对脂肪变性的一致性近乎完美（κ=0.816，95%置信区间 0.674，0.958），对气球样变的一致性较好（κ=0.740，95%置信区间 0.565，0.916），对小叶炎症（κ=0.401，95%置信区间 0.110，0.692）和纤维化（κ=0.473，95%置信区间 0.275，0.672）的一致性为中度。通过盲法重复幻灯片阅读评估的观察者内变异性对于纤维化和脂肪变性几乎为完美（κ=1，95%置信区间 1，1 和 κ=0.939，95%置信区间 0.881，0.997），对于小叶炎症为显著（κ=0.725，95%置信区间 0.584，0.866）。只有右叶评估在 21%的病例中低估了纤维化，在 13%的病例中低估了炎症，在 8%的病例中低估了脂肪变性和气球样变。
结论
这些数据表明，在 NAFLD 中，由于区域变异，EUS 引导的双叶 LB 可改善疾病活动度和纤维化的评估。
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