瞬时弹性成像技术诊断酒精性肝病的价值探讨

目的探讨瞬时弹性成像技术(FibroScan)非侵入性检查诊断酒精性肝病的价值。方法使用FibroScan测量肝脏硬度,并予以量化。对98例酗酒者进行FibroScan检查,并对肝脏硬度超过13kPa的患者进行肝活检,评价其诊断肝纤维化的效能。结果肝脏硬度超过13kPa的53例患者中,9例患者由于超重未能得出准确的测量数值,8例拒绝肝活检,3例因患有其他疾病而未能进行肝活检。在33例肝活检患者中,12例确诊为肝纤维化,21例为肝硬化。肝脏硬度阈值为13kPa的酗酒患者存在肝硬化的阳性预测值为97%。结论 FibroScanR诊断肝纤维化及肝硬化有很高的阳性预测值。我们认为:1,肝脏硬度低于8kPa的酗酒患者可能不存在肝纤维化;2,肝脏硬度介于8.0至13.0kPa之间时,肝纤维化可能正在形成;3,肝脏硬度超过13kPa时,肝硬化已经形成,应该考虑为该类患者制订有效的治疗方案。

FibroScan(R) is a new apparatus allowing noninvasive quantification of liver fibrosis by measuring the stiffness of the liver in patients with alcohol abuse

Objective The aim of this study was to evaluate the acceptability of FibroScan in detection of cirrhosis and the distribution of liver fibrosis in alcohol consulting out-patients.Methods 98 consecutive patients were included and needle liver biopsy was proposed when liver stiffness exceeded 13 kPa.Results The measurement could not be performed correctly in 9 patients because of excess weight.Of the 53 patients with liver stiffness greater than 13 kPa,8 refused liver biopsy and three were primarily managed for other diseases.In the 33 patients in whom liver biopsy was performed,the presence of cirrhosis was confirmed in 21 cases and liver fibrosis in 12 cases.Conclusion FibroScanR allows the diagnosis of cirrhosis with a high positive predictive value(97%) and assesses non-invasively liver fibrosis.We can formulate the following hypothesis which remains to be confirmed: below 8 kPa,there is probably no significant fibrosis;For patients between 8 and 13 kPa,the hepatic fibrosis is accumulating;and finally,beyond 13 kPa,the cirrhosis is established and a specific treatment should be implemented.