Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Road II, Yuexiu District, Guangzhou, 510080, Guangdong, People's Republic of China.
Department of Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, People's Republic of China.
Hepatol Int. 2020 Mar;14(2):190-201. doi: 10.1007/s12072-020-10017-1. Epub 2020 Feb 20.
Two-dimensional shear wave elastography (2D-SWE) is the latest generation of ultrasound elastography for the non-invasive assessment of liver fibrosis in chronic hepatitis B (CHB). We aimed to identify confounders of 2D-SWE in fibrosis grading.
A prospective cohort of 440 CHB patients (286 with liver biopsy and 154 with clinical decompensated cirrhosis) was consecutively enrolled from a clinical trial (registration number: ChiCTR-DCD-15006000) aimed at optimizing 2D-SWE assessments from 2015 to 2018. All patients underwent 2D-SWE examination, anthropometric measurement, and serum biomarker assessment. Steatosis was graded by the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF).
Overall, the prevalence of incorrect fibrosis staging by 2D-SWE was 26.1% (n = 115), with 43.5% of patients under-staged and 56.5% over-staged. In multivariate analysis, the steatosis degree was an independent predictor of 2D-SWE discordance in the overall cohort, with moderate-severe steatosis for underestimation (odds ratio, [OR] = 4.3, 95% confidence interval [CI] 1.2-18.2, p = 0.049) and overestimation (OR = 8.2, 95% CI 2.9-23.5, p < 0.001), and mild steatosis for overestimation (OR = 3.7, 95% CI 1.5-9.0, p = 0.004). In patients with liver biopsy, both histological inflammation activity over 2 (OR = 5.0, 95% CI 2.0-25.3, p = 0.048) and moderate-severe steatosis (OR = 5.2, 95% CI 2.1-13.4, p < 0.001) were independent factors associated with discordance. For the risk of 2D-SWE mis-staging, a nomogram that integrated these confounders was established and the area under the receiver operating characteristic curve of the model was 0.861.
Steatosis and inflammation activities were confounders for 2D-SWE. The combination of these confounders could predict mis-staging risks of CHB-related fibrosis with 2D-SWE and may be valuable to decision-making on liver biopsy for fibrosis staging.
二维剪切波弹性成像（2D-SWE）是用于评估慢性乙型肝炎（CHB）患者肝纤维化的最新一代超声弹性成像技术。我们旨在确定 2D-SWE 在纤维化分级中的混杂因素。
一项前瞻性队列研究纳入了 440 例 CHB 患者（286 例接受肝活检，154 例有临床失代偿性肝硬化），这些患者来自于一项旨在优化 2D-SWE 评估的临床试验（注册号：ChiCTR-DCD-15006000），该研究于 2015 年至 2018 年进行。所有患者均接受 2D-SWE 检查、人体测量和血清生物标志物评估。磁共振成像衍生质子密度脂肪分数（MRI-PDFF）用于评估脂肪变性程度。
总体而言，2D-SWE 不正确纤维化分期的发生率为 26.1%（n=115），43.5%的患者分期过低，56.5%的患者分期过高。多变量分析显示，脂肪变性程度是总体队列中 2D-SWE 不一致的独立预测因素，中重度脂肪变性与低估（比值比 [OR] = 4.3，95%置信区间 [CI] 1.2-18.2，p = 0.049）和高估（OR = 8.2，95% CI 2.9-23.5，p < 0.001）相关，轻度脂肪变性与高估（OR = 3.7，95% CI 1.5-9.0，p = 0.004）相关。在接受肝活检的患者中，组织学炎症活动度大于 2（OR = 5.0，95% CI 2.0-25.3，p = 0.048）和中重度脂肪变性（OR = 5.2，95% CI 2.1-13.4，p < 0.001）是与不一致相关的独立因素。对于 2D-SWE 误分期的风险，建立了一个整合这些混杂因素的列线图，该模型的受试者工作特征曲线下面积为 0.861。
脂肪变性和炎症活动是 2D-SWE 的混杂因素。这些混杂因素的结合可以预测与 2D-SWE 相关的 CHB 相关性纤维化的误分期风险，对于决定是否进行肝活检以进行纤维化分期可能具有重要价值。
