Department of Visceral Surgery and Medicine, Inselspital- Bern University Hospital, University of Bern, Bern, Switzerland.
Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland.
Liver Int. 2022 Jan;42(1):102-111. doi: 10.1111/liv.15116. Epub 2021 Dec 3.
In patients with non-alcoholic fatty liver disease (NAFLD), the impact of the severity of steatosis and inflammatory activity on the accuracy of liver stiffness measurement (LSM) by transient elastography (TE) and by two-dimensional shear wave elastography (2D-SWE) in staging liver fibrosis is still debated and scarce. We aimed to focus on this aspect.
We prospectively studied 104 patients requiring biopsy for the assessment of NAFLD. We used ordinary least squares regression to test for differences in the association between fibrosis and LSM by TE and 2D-SWE when other factors (steatosis and inflammatory activity) are considered.
Among 104 patients, 102 had reliable LSM by TE, and 88 had valid LSM by 2D-SWE. The association between fibrosis based on histology and LSM was significantly stronger when 2D-SWE assessed LSM compared to TE (Spearman's correlation coefficient of .71; P < .001 vs .51, P < .001; Z = 2.21, P = .027). Inflammatory activity was an independent predictor of LSM by TE but not of LSM by 2D-SWE. After controlling for fibrosis, age, sex and body mass index, the inflammatory activity and the interaction between inflammatory activity and fibrosis independently explained 11% and 13% of variance in LSM by TE respectively. Steatosis did not affect the association of fibrosis and LSM by either method.
Inflammatory activity on histology significantly affects LSM by TE, but not LSM by 2D-SWE in NAFLD. LSM by 2D-SWE reflects liver fibrosis more accurately than LSM by TE. Furthermore, the severity of steatosis on histology did not influence the association of LSM and fibrosis by either elastography method.
在非酒精性脂肪性肝病（NAFLD）患者中，肝硬度测量（LSM）的瞬时弹性成像（TE）和二维剪切波弹性成像（2D-SWE）的严重程度对纤维化分期的准确性的影响仍存在争议且相关研究较少。我们旨在关注这一方面。
我们前瞻性研究了 104 例因评估非酒精性脂肪性肝病而需要进行肝活检的患者。我们使用普通最小二乘法回归来检验当考虑其他因素（脂肪变性和炎症活动）时，纤维化与 TE 和 2D-SWE 的 LSM 之间的相关性差异。
在 104 例患者中，有 102 例患者的 TE 测量的 LSM 结果可靠，有 88 例患者的 2D-SWE 测量的 LSM 结果有效。与 TE 相比，基于组织学的纤维化与 LSM 的相关性通过 2D-SWE 评估时更显著（Spearman 相关系数分别为.71；P<0.001 与.51，P<0.001；Z=2.21，P=0.027）。炎症活动是 TE 测量的 LSM 的独立预测因子，但不是 2D-SWE 测量的 LSM 的独立预测因子。在控制纤维化、年龄、性别和体重指数后，炎症活动及其与纤维化的相互作用分别独立解释了 TE 测量的 LSM 的 11%和 13%的方差。在两种方法中，脂肪变性均不影响纤维化与 LSM 的相关性。
组织学上的炎症活动显著影响 TE 测量的 LSM，但不影响 2D-SWE 测量的 LSM 在 NAFLD 中的影响。2D-SWE 测量的 LSM 比 TE 测量的 LSM 更能准确地反映肝纤维化。此外，组织学上的脂肪变性严重程度不影响两种弹性成像方法中 LSM 与纤维化的相关性。
