Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
J Viral Hepat. 2020 Apr;27(4):437-448. doi: 10.1111/jvh.13246. Epub 2019 Dec 23.
Ultrasound-based elastography and serum indexes have been individually validated as noninvasive methods for staging liver fibrosis in chronic viral hepatitis. We aimed to compare the accuracy of transient elastography (TE), shear wave elastography (SWE), aspartate aminotransferase to platelet index (APRI) and Fibrosis-4 index (FIB-4) with the METAVIR liver fibrosis staging in viral hepatitis patients. We enrolled 121 treatment-naïve chronic hepatitis B and C monoinfected patients. All underwent liver biopsy had biochemistry tests and liver stiffness measurements by TE using M and XL probes followed by point SWE performed on the same day. The accuracy of each method for predicting different fibrosis stages was demonstrated as an area under the receiver operating characteristic (AUROC) curves. The AUROCs of TE using M and XL probes, SWE, APRI and FIB-4 were 0.771, 0.761, 0.700, 0.698 and 0.697, respectively, for significant fibrosis; 0.974, 0.973, 0.929, 0.738 and 0.859, respectively, for advanced fibrosis; and 0.954, 0.949, 0.962, 0.765 and 0.962, respectively, for cirrhosis. TE using the M probe was comparable to the XL probe in detecting all fibrosis stages. TE was superior to SWE for assessing significant fibrosis and advanced fibrosis. For cirrhosis, the performances of TE, SWE and FIB-4 were similar. APRI was least accurate in liver fibrosis staging. To conclude, for patients with viral hepatitis, TE using either M or XL probe is an effective noninvasive test for assessing liver fibrosis, particularly advanced fibrosis and cirrhosis, while SWE and FIB-4 possess an excellent accuracy in predicting cirrhosis.
超声弹性成像和血清指标已被分别验证为慢性病毒性肝炎肝纤维化分期的非侵入性方法。我们旨在比较瞬时弹性成像（TE）、剪切波弹性成像（SWE）、天冬氨酸氨基转移酶血小板指数（APRI）和纤维化-4 指数（FIB-4）与 METAVIR 肝纤维化分期在病毒性肝炎患者中的准确性。我们招募了 121 名未经治疗的慢性乙型和丙型肝炎单感染患者。所有患者均接受了肝活检、生化检查和使用 M 和 XL 探头进行的 TE 肝硬度测量，随后在同一天进行了点 SWE。每种方法预测不同纤维化阶段的准确性均表现为接受者操作特征（ROC）曲线下的面积（AUROC）。使用 M 和 XL 探头的 TE、SWE、APRI 和 FIB-4 的 AUROC 分别为 0.771、0.761、0.700、0.698 和 0.697，用于显著纤维化；0.974、0.973、0.929、0.738 和 0.859，用于进展性纤维化；以及 0.954、0.949、0.962、0.765 和 0.962，用于肝硬化。使用 M 探头的 TE 在检测所有纤维化阶段方面与 XL 探头相当。TE 在评估显著纤维化和进展性纤维化方面优于 SWE。对于肝硬化，TE、SWE 和 FIB-4 的表现相似。APRI 在肝纤维化分期中准确性最低。总之，对于病毒性肝炎患者，使用 M 或 XL 探头的 TE 是评估肝纤维化的有效非侵入性试验，特别是进展性纤维化和肝硬化，而 SWE 和 FIB-4 在预测肝硬化方面具有优异的准确性。
