使用受控衰减参数和肝脏硬度测量评估肝移植受者的脂肪变性和纤维化。
Assessment of Steatosis and Fibrosis in Liver Transplant Recipients Using Controlled Attenuation Parameter and Liver Stiffness Measurements.
机构信息
Department of Gastroenterology, University Hospital Center Rijeka, Rijeka, Croatia.
Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia.
出版信息
Can J Gastroenterol Hepatol. 2021 Feb 8;2021:6657047. doi: 10.1155/2021/6657047. eCollection 2021.
AIM
The primary objective of this study was to evaluate the prevalence of increased controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as surrogate markers of liver steatosis and fibrosis in liver transplant recipient (LTR). Secondary objectives were to determine the predictors of increased CAP and LSM in population of LTR.
METHODS
In this prospective, cross-sectional study, we have evaluated 175 LTRs' mean age as 61 (53-65) with a functioning graft for more than one year who came for regular outpatient examinations to the Department of Gastroenterology, University Hospital (UH) Merkur, Zagreb, Croatia.
RESULTS
Of 175 analyzed LTRs, 34.28% had obesity, 64.00% had hypertension, 38.28% had diabetes, and 58.85% had hyperlipidemia. The prevalence of liver steatosis was 68.57%, while the prevalence of severe liver steatosis was 46.85%. On multivariate analysis, independent factors associated with liver steatosis were male gender, total cholesterol as positive predictor, and HDL as negative predictor, and independent factors positively associated with severe liver steatosis were higher body mass index (BMI) and higher triglyceride levels. The prevalence of moderate liver fibrosis was 54.85%, while the prevalence of advanced liver fibrosis was 24%. On multivariate analysis, independent factors positively associated with moderate fibrosis were gamma-glutamyl transferase (GGT) and CAP, while the independent factor positively associated with advanced fibrosis was GGT.
CONCLUSION
Our study showed high prevalence of increased CAP and LSM measurements as surrogate markers of liver steatosis and fibrosis. Metabolic syndrome components were highly present and were associated with CAP and LSM values as well as in the pretransplant setting. Due to high prevalence of metabolic comorbidities and nonalcoholic fatty liver disease in LTRs and the lack of the abnormal liver test in a significant number of these patients, TE with CAP may be a reasonable initial assessment for LTRs with one or more components of the metabolic syndrome.
目的
本研究的主要目的是评估肝移植受者（LTR）中作为肝脂肪变性和纤维化替代标志物的受控衰减参数（CAP）和肝硬度测量值（LSM）升高的患病率。次要目标是确定 LTR 人群中 CAP 和 LSM 升高的预测因素。
方法
在这项前瞻性、横断面研究中，我们评估了 175 名年龄为 61 岁（53-65 岁）的 LTR，他们的移植物功能正常超过一年，这些人因定期门诊检查来到克罗地亚扎格勒布 UH Merkur 大学医院消化内科。
结果
在 175 名分析的 LTR 中，34.28%有肥胖，64.00%有高血压，38.28%有糖尿病，58.85%有高血脂。肝脂肪变性的患病率为 68.57%，而严重肝脂肪变性的患病率为 46.85%。多变量分析显示，与肝脂肪变性相关的独立因素是男性、总胆固醇作为阳性预测因素、高密度脂蛋白作为阴性预测因素，与严重肝脂肪变性相关的独立因素是较高的体重指数（BMI）和较高的甘油三酯水平。中度肝纤维化的患病率为 54.85%，而晚期肝纤维化的患病率为 24%。多变量分析显示，与中度纤维化相关的独立因素是γ-谷氨酰转移酶（GGT）和 CAP，而与晚期纤维化相关的独立因素是 GGT。
结论
我们的研究表明，CAP 和 LSM 测量值升高作为肝脂肪变性和纤维化的替代标志物的患病率很高。代谢综合征成分高度存在，并与 CAP 和 LSM 值以及移植前环境相关。由于 LTR 中代谢合并症和非酒精性脂肪性肝病的高患病率，以及这些患者中相当一部分的肝功能检查异常，对于具有代谢综合征一个或多个成分的 LTR，TE 联合 CAP 可能是一种合理的初始评估方法。
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