在普通人群中使用超声剪切波速度测量来检测晚期肝纤维化。
Detecting advanced liver fibrosis using ultrasound shear wave velocity measurement in the general population.
作者信息
Kirino Sakura, Tamaki Nobuharu, Kurosaki Masayuki, Takahashi Yuka, Higuchi Mayu, Itakura Yoshie, Tanaka Yuki, Inada Kento, Ishido Shun, Yamashita Koji, Nobusawa Tsubasa, Matsumoto Hiroaki, Hayakawa Yuka, Kakegawa Tatsuya, Takaura Kenta, Tanaka Shohei, Maeyashiki Chiaki, Kaneko Shun, Yasui Yutaka, Tsuchiya Kaoru, Nakanishi Hiroyuki, Okamoto Ryuichi, Izumi Namiki
机构信息
Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
Quant Imaging Med Surg. 2023 Oct 1;13(10):6493-6502. doi: 10.21037/qims-23-511. Epub 2023 Aug 28.
BACKGROUND
Advanced fibrosis detection in the general population is an unmet need. Additionally, screening method for advanced fibrosis in the general population is not established. Thus, this study aimed to examine the use of shear wave measurement (SWM), which measures liver stiffness by ultrasound elastography as a screening tool for advanced fibrosis in health checkups that represents the general population.
METHODS
SWM was performed in all subjects. Magnetic resonance elastography (MRE) was performed in those with SWM shear wave velocity (Vs) ≥1.3 m/s to determinate advanced fibrosis. The diagnostic accuracy of SWM Vs for advanced fibrosis (determined by MRE of ≥3.62 kPa) was examined. This prospective study was registered with the University Hospital Medical Information Network clinical trial registry (UMIN000041609).
RESULTS
A total of 2,233 subjects were included. SWM Vs of 1.64 m/s was selected as the best threshold for advanced fibrosis. Using the threshold of SWM Vs at ≥1.64 m/s, subjects were narrowed down to 1.7%, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for advanced fibrosis were 53.3%, 92.4%, 47.1%, and 94.0%, respectively, among these subjects. The multivariable analysis, after adjusting the age, sex, body mass index (BMI), hypertension, diabetes mellitus (DM), dyslipidemia, and alcohol use, revealed an SWM Vs of ≥1.64 m/s as the significant factor for advanced fibrosis with an odds ratio (95% confidence interval) of 14.5 (3.4-62; P<0.001).
CONCLUSIONS
SWM has high diagnostic accuracy for advanced fibrosis (PPV 47.1%) and may be used as a screening tool for liver fibrosis in the general population.
背景
在普通人群中进行晚期肝纤维化检测是一项尚未满足的需求。此外，普通人群中晚期肝纤维化的筛查方法尚未确立。因此，本研究旨在探讨使用通过超声弹性成像测量肝脏硬度的剪切波测量（SWM）作为代表普通人群的健康体检中晚期肝纤维化的筛查工具。
方法
对所有受试者进行SWM检查。对SWM剪切波速度（Vs）≥1.3 m/s的受试者进行磁共振弹性成像（MRE）检查以确定晚期肝纤维化。检测SWM Vs对晚期肝纤维化（由MRE确定为≥3.62 kPa）的诊断准确性。这项前瞻性研究已在大学医院医学信息网络临床试验注册中心（UMIN000041609）注册。
结果
共纳入2233名受试者。选择1.64 m/s的SWM Vs作为晚期肝纤维化的最佳阈值。使用SWM Vs≥1.64 m/s的阈值，将受试者缩小至1.7%，在这些受试者中，晚期肝纤维化的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为53.3%、92.4%、47.1%和94.0%。在调整年龄、性别、体重指数（BMI）、高血压、糖尿病（DM）、血脂异常和饮酒情况后的多变量分析显示，SWM Vs≥1.64 m/s是晚期肝纤维化的显著因素，优势比（95%置信区间）为14.5（3.4 - 62；P<0.001）。
结论
SWM对晚期肝纤维化具有较高的诊断准确性（PPV 47.1%），可作为普通人群肝纤维化的筛查工具。
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