Rasool Nida, Hyder Ali, Tareen Khaild, Ahmed Imran, Iqbal Samra, Kauser Siddiqui Marium, Yaseen Khan Raja Taha, Hassan Luck Nasir
Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK.
Gastroenterology, Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK.
Cureus. 2025 Jan 2;17(1):e76789. doi: 10.7759/cureus.76789. eCollection 2025 Jan.
Background Autoimmune hepatitis (AIH) is a chronic inflammatory condition affecting the liver, ultimately leading to fibrosis, followed by cirrhosis and liver failure. Although liver biopsy is necessary to confirm the disease and outline different stages of liver fibrosis, it is associated with several risks due to its invasiveness. Shear-wave elastography (SWE) has recently emerged as a non-invasive imaging modality, representing liver stiffness and providing additional fibrosis assessment. This study aims to validate SWE for diagnosing and discriminating liver fibrosis stage in AIH patients. Methodology This retrospective cohort study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, with the enrollment of 162 patients diagnosed with AIH between March 2022 and December 2023. All participants underwent SWE and liver biopsy. The stages of fibrosis were assessed using the Metavir scoring system. Demographic, biochemical, and serological data were analyzed, including autoantibody and serum IgG levels. Diagnostic accuracy, sensitivity, and specificity of SWE were compared with histopathological findings. Results Of the 162 patients, 71 (43.8%) were males, and 91 (56.2%) were females, with a mean age of 35.8 ± 16.6 years. SWE had an overall diagnostic accuracy of 92.11%, sensitivity of 82.86%, and specificity of 98.7% in predicting fibrosis stages. SWE was effective in differentiating early fibrosis (F1-F2), while it showed reduced sensitivity for advanced fibrosis (F3-F4). Female gender (p = 0.009), elevated bilirubin (p = 0.009), autoantibody titers, and serum IgG levels (p = 0.043) were significant factors related to advanced fibrosis. Conclusions SWE has shown high diagnostic accuracy and specificity for the estimation of liver fibrosis in AIH, especially in the early stages. Sensitivity is lowered in advanced fibrosis. SWE is a very valuable non-invasive alternative to liver biopsy. Its use may decrease procedural risks, accelerate diagnosis, and improve outcomes in AIH. Further multicenter studies are recommended for confirmation and to explore the comparative performance of SWE against other non-invasive approaches.
自身免疫性肝炎（AIH）是一种影响肝脏的慢性炎症性疾病，最终会导致肝纤维化，继而发展为肝硬化和肝衰竭。尽管肝活检对于确诊该病以及明确肝纤维化的不同阶段是必要的，但由于其具有侵入性，存在多种风险。剪切波弹性成像（SWE）最近作为一种非侵入性成像方式出现，可反映肝脏硬度并提供额外的纤维化评估。本研究旨在验证SWE在诊断和鉴别AIH患者肝纤维化阶段方面的作用。
本回顾性队列研究在卡拉奇的信德泌尿与移植研究所进行，纳入了2022年3月至2023年12月期间确诊为AIH的162例患者。所有参与者均接受了SWE检查和肝活检。使用梅塔维评分系统评估纤维化阶段。分析了人口统计学、生化和血清学数据，包括自身抗体和血清IgG水平。将SWE的诊断准确性、敏感性和特异性与组织病理学结果进行比较。
162例患者中，71例（43.8%）为男性，91例（56.2%）为女性，平均年龄为35.8±16.6岁。SWE在预测纤维化阶段方面的总体诊断准确性为92.11%，敏感性为82.86%，特异性为98.7%。SWE在区分早期纤维化（F1 - F2）方面有效，而对晚期纤维化（F3 - F4）的敏感性降低。女性性别（p = 0.009）、胆红素升高（p = 0.009）、自身抗体滴度和血清IgG水平（p = 0.043）是与晚期纤维化相关的重要因素。
SWE在估计AIH患者肝纤维化方面显示出较高的诊断准确性和特异性，尤其是在早期阶段。晚期纤维化时敏感性降低。SWE是肝活检非常有价值的非侵入性替代方法。其应用可能会降低操作风险、加快诊断并改善AIH的治疗结果。建议进一步开展多中心研究以进行确认，并探索SWE与其他非侵入性方法相比的性能。
