慢性病毒性肝炎和非酒精性脂肪性肝病患者弹性成像点定量与瞬时弹性成像的比较：一项初步研究
Comparison of Elastography Point Quantification with Transient Elastography in Patients with Chronic Viral Hepatitis and Nonalcoholic Fatty Liver Disease: A Pilot Study.
作者信息
Kapur Savinay, Kalra Naveen, Bhatia Anmol, Duseja Ajay, Das Ashim, Dhiman Radha K, Chawla Yogesh, Sandhu Manavjit S
机构信息
Departments of Radiodiagnosis and Imaging, Chandigarh, 160012, India.
Departments of Hepatology, Chandigarh, 160012, India.
出版信息
J Clin Exp Hepatol. 2021 Jan-Feb;11(1):21-29. doi: 10.1016/j.jceh.2020.06.005. Epub 2020 Jul 2.
AIMS
The objective of this study was to compare diagnostic accuracy of elastography point quantification (ElastPQ) with transient elastography (TE) and liver histology for measuring liver stiffness in patients with chronic viral hepatitis (CVH) and nonalcoholic fatty liver disease (NAFLD).
METHODS
Thirty-two patients with chronic liver disease (CVH and NAFLD) were evaluated by ElastPQ and TE within 7 days of liver biopsy. Within the CVH group, subgroup analysis was carried out in patients with end-stage renal disease (ESRD) and without ESRD. Area under the receiver operating characteristic (AUROC) curves were calculated for ElastPQ and TE.
RESULTS
There were 15 patients with CVH and 17 patients with NAFLD. In the CVH group, there were 8 patients with ESRD and 7 patients without ESRD. Taking liver histopathology as the gold standard, liver stiffness measurement by ElastPQ (ρ = 0.826; < 0.0001) and TE (ρ = 0.649; < 0.0001) correlated significantly with the stage of fibrosis. AUROCs of ElastPQ and TE for the diagnosis of any fibrosis (F ≥ 1), significant fibrosis (F ≥ 2), and advanced fibrosis (F ≥ 3) were 0.907, 0.959, 0.926 and 0.870, 0.770, 0.881, respectively, in both CVH and NAFLD groups. However, the accuracy of both these techniques was poor in patients with CVH and ESRD (AUROCs for ElastPQ and TE of 0.667 and 0.167 for the diagnosis of significant fibrosis, respectively, and 0.429 and 0.143 for the diagnosis of advanced fibrosis, respectively). The diagnostic accuracy of both ElastPQ and TE for detecting significant fibrosis was excellent in patients with NAFLD (AUROC of 1.000 and 0.936, respectively). ElastPQ was superior to TE in the diagnosis of significant fibrosis in the combined analysis ( = 0.0149) and in the CVH group ( = 0.0391), while both modalities were comparable in patients of the NAFLD group ( = 0.2539).
CONCLUSION
ElastPQ may be equally accurate as Fibroscan, and large prospective studies are required to validate the same.
目的
本研究的目的是比较弹性成像点量化（ElastPQ）与瞬时弹性成像（TE）以及肝脏组织学在测量慢性病毒性肝炎（CVH）和非酒精性脂肪性肝病（NAFLD）患者肝脏硬度方面的诊断准确性。
方法
32例慢性肝病（CVH和NAFLD）患者在肝活检7天内接受了ElastPQ和TE评估。在CVH组中，对患有终末期肾病（ESRD）和未患ESRD的患者进行了亚组分析。计算了ElastPQ和TE的受试者操作特征曲线下面积（AUROC）。
结果
有15例CVH患者和17例NAFLD患者。在CVH组中，有8例ESRD患者和7例非ESRD患者。以肝脏组织病理学为金标准，通过ElastPQ（ρ = 0.826；<0.0001）和TE（ρ = 0.649；<0.0001）测量的肝脏硬度与纤维化阶段显著相关。在CVH和NAFLD组中，ElastPQ和TE诊断任何纤维化（F≥1）、显著纤维化（F≥2）和晚期纤维化（F≥3）的AUROC分别为0.907、0.959、0.926和0.870、0.770、0.881。然而，在CVH和ESRD患者中，这两种技术的准确性都很差（ElastPQ和TE诊断显著纤维化的AUROC分别为0.667和0.167，诊断晚期纤维化的AUROC分别为0.429和0.143）。在NAFLD患者中，ElastPQ和TE检测显著纤维化的诊断准确性都很高（AUROC分别为1.000和0.936）。在联合分析中（P = 0.0149）以及在CVH组中（P = 0.0391），ElastPQ在诊断显著纤维化方面优于TE，而在NAFLD组患者中，两种方法相当（P = 0.2539）。
结论
ElastPQ可能与Fibroscan同样准确，需要大型前瞻性研究来验证这一点。
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