瞬时弹性成像评估慢性病毒性肝炎肝纤维化的准确性：一项多中心回顾性研究。
Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: A multicentre, retrospective study.
作者信息
Seo Yeon Seok, Kim Moon Young, Kim Seung Up, Hyun Bae Si, Jang Jae Young, Lee Jin Woo, Lee Jung Il, Suh Sang Jun, Park Soo Young, Park Hana, Jung Eun Uk, Kim Byung Seok, Kim In Hee, Lee Tae Hee, Um Soon Ho, Han Kwang-Hyub, Kim Sang Gyune, Paik Soon Koo, Choi Jong Young, Jeong Soung Won, Jin Young Joo, Lee Kwan Sik, Yim Hyung Joon, Tak Won Young, Hwang Seong Gyu, Lee Youn Jae, Lee Chang Hyeong, Kim Dae-Ghon, Kang Young Woo, Kim Young Seok
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, South Korea.
Yonsei University, Wonju College of Medicine, Department of Internal Medicine, Wonju, South Korea.
出版信息
Liver Int. 2015 Oct;35(10):2246-55. doi: 10.1111/liv.12808. Epub 2015 Feb 26.
BACKGROUND/AIMS: Transient elastography (TE) has become an alternative to liver biopsy (LB). This study investigated the diagnostic performance of liver stiffness (LS) measurement using TE in Korean patients with chronic hepatitis B and C (CHB and CHC).
METHODS
From April 2006 to June 2014, 916 patients (567 CHB and 349 CHC) who underwent LB and TE at 15 centres were analyzed. The Batts and Ludwig scoring system was used for histologic assessment. Aspartate aminotransferase (AST)-to-platelet ratio indexes (APRI) were calculated. Area under the receiver operating characteristic curve (AUROC) was used.
RESULTS
The median age, LS value, and APRI score were 45 years, 8.8 kPa, and 0.61, respectively, in CHB patients vs. 51 years, 6.8 kPa and 0.55, respectively, in CHC patients. TE was significantly superior to APRI in CHB patients (AUROC 0.774 vs. 0.72 for ≥F2, 0.849 vs. 0.812 for ≥F3, and 0.902 vs. 0.707 for F4, respectively; all P < 0.05). Furthermore, TE was significantly superior for predicting ≥ F3 stage (AUROC 0.865 vs. 0.840, P = 0.009) whereas it was similar for predicting ≥ F2 and F4 stage (AUROC 0.822 vs. 0.796; 0.910 vs. 0.884; all P > 0.05) in CHC patients. In CHB patients, optimal cut-off LS values were 7.8 kPa for ≥F2, 8.2 kPa for ≥ F3, and 11.6 kPa for F4, vs. 6.8 kPa, 8.6 kPa, and 14.5 kPa, respectively, in CHC patients.
CONCLUSIONS
TE can accurately assess the degree of liver fibrosis in Korean patients with CVH. TE was superior to APRI for predicting each fibrosis stage.
背景/目的：瞬时弹性成像（TE）已成为肝活检（LB）的替代方法。本研究调查了TE测量肝硬度（LS）在韩国慢性乙型肝炎和丙型肝炎（CHB和CHC）患者中的诊断性能。
方法
分析了2006年4月至2014年6月期间在15个中心接受LB和TE检查的916例患者（567例CHB和349例CHC）。采用Batts和Ludwig评分系统进行组织学评估。计算天冬氨酸转氨酶（AST）与血小板比值指数（APRI）。使用受试者操作特征曲线下面积（AUROC）。
结果
CHB患者的中位年龄、LS值和APRI评分分别为45岁、8.8 kPa和0.61，而CHC患者分别为51岁、6.8 kPa和0.55。在CHB患者中，TE显著优于APRI（对于≥F2，AUROC分别为0.774对0.72；对于≥F3，为0.849对0.812；对于F4，为0.902对0.707；所有P<0.05）。此外，在CHC患者中，TE在预测≥F3期方面显著更优（AUROC为0.865对0.840，P = 0.009），而在预测≥F2和F4期方面相似（AUROC分别为0.822对0.796；0.910对0.884；所有P>0.05）。在CHB患者中，≥F2的最佳LS截断值为7.8 kPa，≥F3为8.2 kPa，F4为11.6 kPa，而在CHC患者中分别为6.8 kPa, 8.6 kPa和14.5 kPa。
结论
TE可以准确评估韩国慢性病毒性肝炎（CVH）患者的肝纤维化程度。在预测各纤维化阶段方面，TE优于APRI。
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