Oeda Satoshi, Tanaka Kenichi, Oshima Ayaka, Matsumoto Yasue, Sueoka Eisaburo, Takahashi Hirokazu
Liver Center, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan.
Department of Laboratory Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga 849-8501, Japan.
Diagnostics (Basel). 2020 Nov 12;10(11):940. doi: 10.3390/diagnostics10110940.
Evaluating liver steatosis and fibrosis is important for patients with non-alcoholic fatty liver disease. Although liver biopsy and pathological assessment is the gold standard for these conditions, this technique has several disadvantages. The evaluation of steatosis and fibrosis using ultrasound B-mode imaging is qualitative and subjective. The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) determined using FibroScan are the evidence-based non-invasive measures of liver fibrosis and steatosis, respectively. The LSM and CAP measurements are carried out simultaneously, and the median values of more than ten valid measurements are used to quantify liver fibrosis and steatosis. Here, we demonstrate that the reliability of the LSM depends on the interquartile range to median ratio (IQR/Med), but CAP values do not depend on IQR/Med. In addition, the LSM is affected by inflammation, congestion, and cholestasis in addition to fibrosis, while CAP values are affected by the body mass index in addition to steatosis. We also show that the M probe provides higher LSM values but lower CAP values than the XL probe in the same population. However, there was no statistically significant difference between the diagnostic accuracies of the two probes. These findings are important to understand the reliability of FibroScan measurements and the factors influencing measurement values for all patients.
评估非酒精性脂肪性肝病患者的肝脏脂肪变性和纤维化具有重要意义。尽管肝活检和病理评估是这些病症的金标准，但该技术存在若干缺点。使用超声B模式成像评估脂肪变性和纤维化具有定性和主观性。使用FibroScan测定的肝脏硬度值（LSM）和受控衰减参数（CAP）分别是基于证据的肝脏纤维化和脂肪变性的非侵入性测量方法。LSM和CAP测量同时进行，使用十多次有效测量的中位数来量化肝脏纤维化和脂肪变性。在此，我们证明LSM的可靠性取决于四分位数间距与中位数之比（IQR/Med），而CAP值不依赖于IQR/Med。此外，LSM除了受纤维化影响外，还受炎症、充血和胆汁淤积的影响，而CAP值除了受脂肪变性影响外，还受体重指数的影响。我们还表明，在同一人群中，M探头提供的LSM值高于XL探头，但CAP值低于XL探头。然而，两种探头的诊断准确性之间没有统计学上的显著差异。这些发现对于理解所有患者FibroScan测量的可靠性以及影响测量值的因素具有重要意义。
