FibroScan对原发性胆汁性肝硬化患者肝纤维化的诊断价值

目的探讨FibroScan对于原发性胆汁性肝硬化（primary biliary cirrhosis,PBC）肝纤维化诊断的准确性。方法选择2009年10月—2013年12月经肝脏穿刺病理诊断的PBC患者56例,进行FibroScan检测得到肝脏硬度测量（liver stiffness measurement,LSM）值。以肝脏活组织检查结果作为＂金标准＂,计算受试者工作特征曲线下面积（AUROC）,评价FibroScan对PBC肝纤维化的诊断价值。结果 LSM值平均为（13.714±7.475）kPa,与肝脏病理分期呈正相关,Kendall相关系数为0.897,P〈0.01。FibroScan诊断PBC肝纤维化≥S2期、≥S3期、S4期的AUROC分别为0.897、0.959、0.989。纤维化分期为≥F2、≥F3、F4时对应的最佳截断值分别为12.9、16.1和19.7 kPa。肝硬度、血清透明质酸、AST/PLT（APRI）均为肝脏病理分期独立相关因素。结论 FibroScan是一项方便、准确的用于诊断PBC肝纤维化程度的方法。     

慢性乙型肝炎肝硬化FibroScan测量结果与肝穿刺病理的关系

目的探讨慢性乙型肝炎肝硬化FibroScan测量结果与肝穿刺病理的关系。方法选择本院2016年1月至2018年9月收治的慢性乙型肝炎患者93例,均进行FibroScan检查并于1周内进行肝穿刺活检。记录肝穿刺活检结果及FibroScan测量的LSM值。以肝穿刺活检结果为基准计算FibroScan诊断肝纤维化分期的整体符合率与诊断肝硬化的敏感度与特异度。分析FibroScan所测量的LSM值与Knodell评分、活检病理分期的相关性。结果 93例患者中,经肝穿刺活检证实S0期9例、S1期21例、S2期28例、S3期20例、S4期15例,肝硬化发生率16.13%(15/93)。FibroScan检测结果显示,S0期10例、S1期23例、S2期27例、S3期21例、S4期14例。以肝穿刺活检为"金标准",FibroScan诊断肝纤维化分期的整体符合率96.77%(90/93),诊断肝硬化的敏感度100%、特异度93.33%(14/15)。不同纤维化病理分期患者LSM值的差异均存在统计学意义(P0.05)。LSM值与Knodell评分(r=0.861,P=0.000)及活检病理分期(r=0.714,P=0.000)均呈正相关(P0.05)。结论 Fibroscan对慢性乙型肝炎患者肝纤维化分期与肝硬化的诊断有重要意义,且是一种价廉、可靠、无创的检查手段,可重复性高,虽然尚无法完全取代肝组织活检,但在初次活检后随访中的应用前景广阔。     

FibroScan对慢性乙型肝炎肝纤维化诊断的临床价值

目的探讨肝脏瞬时弹性扫描仪(FibroScan)对慢性乙型肝炎(chronic hepatitis B,CHB)肝纤维化的诊断价值。方法对80例行肝脏穿刺检查的CHB患者进行FibroScan检测,记录所检测到的肝脏硬度值。肝纤维化程度分为无或轻度肝纤维化(S0~S1期)、显著肝纤维化(S2~S4期)、严重肝纤维化(S3~S4期)和早期肝硬化(S4期)。以肝脏活体组织检查病理结果为"金标准",绘制受试者工作特征曲线(receiver-operating characteristic curve,ROC曲线),计算ROC曲线下面积(area under ROC curve,AUROC),评价FibroScan对CHB患者肝纤维化的诊断价值。结果肝脏硬度值与肝脏病理分期呈正相关(rs=0.739,P0.01)。FibroScan对显著肝纤维化、严重肝纤维化和早期肝硬化的AUROC值分别为0.865、0.940和0.944。结论 FibroScan可以较准确地估计CHB患者的肝纤维化程度,部分替代有创性的肝脏活体组织检查,对CHB患者肝纤维化的诊断和治疗有指导意义。     

瞬时弹性扫描诊断肝纤维化准确性研究

目的验证瞬时弹性扫描（FibroScan）诊断肝纤维化的准确性。方法选取141例慢性肝病患者,每例均进行肝脏活体组织检查,并应用瞬时弹性扫描仪测量肝脏硬度,以病理检查结果为金标准,验证FibroScan诊断肝纤维化的准确性。结果肝脏硬度与肝纤维化程度密切相关,Kendall相关系数为0．74（P=0．001）。FibroScan诊断肝纤维化F1～F4、F2～F4、F3～F4、F4期的受试者工作特征曲线下面积分别为0．97、O．96、0．99、0．97。结论FibroScan诊断肝纤维化有较好的准确性。     

进食对FibroScan检测乙型肝炎肝纤维化准确性的影响

目的 探讨进食对FibroScan检测乙型肝炎肝纤维化的影响.方法 57例乙型肝炎肝纤维化患者分别于早晨空腹(餐前)和餐后2h(餐后)检测肝脏硬度值,同时行肝脏活体组织检查,以病理结果为“金标准”,分析餐前和餐后肝脏硬度值的差异.结果 餐前和餐后肝脏硬度值差异无统计学意义(P=0.989).病理检查的结果为:餐前FibroScan诊断S2、S3、S4期的受试者工作特征曲线下面积分别为0.93、0.95、0.97,诊断界值分别为8.1、11.0、17.3 kPa;餐后FibroScan诊断S2、S3、S4期的受试者工作特征曲线下面积分别为0.93、0.96、0.95,诊断界值分别为8.0、12.7、16.4 kPa.结论 早晨空腹和餐后2h肝脏硬度值无明显变化,进食对FibroScan检测乙型肝炎肝纤维化无影响.     

瞬时弹性成像检测肝硬度联合脾硬度对慢性乙型肝炎肝纤维化诊断的价值

目的 评价以FibroScan为代表的瞬时弹性成像所检测的肝硬度联合脾硬度对慢性乙型肝炎患者肝纤维化病理分期诊断的价值。方法 回顾性分析2018年1月—2021年12月于联勤保障部队第九〇九医院收治的317例接受肝脏活检的慢性乙型肝炎患者临床资料。利用ROC曲线分析FibroScan所测量的肝脏硬度值(liver stiffness measurement, LSM)、脾脏硬度值(spleen stiffness measurement, SSM)与肝脏病理所诊断纤维化关系。采用logistic回归构建基于LSM和SSM的纤维化分级阶段模型。结果 纳入患者的肝脏病理S0-S1为79例(24.92%),S2为102例(32.18%),S3为87例(27.44%),S4为49例(15.46%)。炎症情况G1为31(9.78%)例，G2为109例(34.38%),G3为128例(40.34%);G4为49例(15.46%)。LSM对显著纤维化(≥S2)、严重纤维化(≥S3)和肝硬化(S4)的最佳诊断LSM值为7.4 kPa(AUC=0.861)、9.8 kPa(AUC=0.909)和16.6...     

FibroScan对慢性药物性肝损害肝纤维化的诊断价值研究

目的 探讨FibroScan对于慢性药物性肝损害(drug-induced liver injury,DILI)肝纤维化的诊断准确性.方法 选择2009年4月-2011年1月在我院住院的经肝脏穿刺病理诊断的慢性DILI患者49例,进行FibroScan检测得到肝脏硬度测量(liver stiffness measurement,LSM)值.以肝脏活体组织检查病理结果为“金标准”绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算ROC曲线下面积(area under the receiver operating characteristic curve,AUROC),以评价FibroScan对慢性DILI肝纤维化的诊断价值.结果 LSM值与肝脏病理分期呈正相关,Kendall相关系数为0.607,P＜0.001.FibroScan诊断慢性DILI肝纤维化≥S2期、≥S3期、S4期的AUROC分别为0.878、0.944、0.993.结论 FibroScan对诊断慢性DILI肝纤维化程度有较好的准确性.     

Fibroscan在慢性乙型肝炎肝纤维化诊断中的作用及影响因素

目的探讨肝脏瞬时弹性超声成像(Fibroscan,FS)在评估慢性乙型肝炎肝纤维化中的作用及影响因素。方法选择上海瑞金医院感染科2009年1月至2011年12月慢性乙型肝炎(CHB)患者410例,运用FS检测肝脏硬度值(Stiffness值)。所有患者同期行经皮肝穿刺活组织检查,同时检测肝功能、血小板、凝血等指标。以肝活检结果为标准绘制FS工作特征曲线,计算受试者工作特征曲线下面积(AUROC),Stiffness值与Ishak评分比对,运用统计学方法进行分析。结果无肝纤维化(S0期)、轻度肝纤维化(S1～S2期)、中度肝纤维化(S3～S4期)和重度肝纤维化及肝硬化(S5期～S6期)患者Stiffness值(kPa)分别为5.45±1.44、7.01±2.42、9.23±3.00、16.87±6.77,对Stiffness值进行组间比较,差异有统计学意义(P<0.01)。Stiffness值与肝纤维化分期呈显著正相关(r=0.67812,P<0.01)。Fibroscan检测显著肝纤维化和肝硬化的AUROC分别为0.840和0.938,其中以Stiffness值8.050kPa作为显著肝纤维化的诊断界值,敏感度为60.3%,特异度为93.7%,阳性预测值为94.71%,阴性预测值为55.83%;以12.150kPa作为重度肝纤维化和肝硬化的诊断界值点,敏感度和特异度分别为75.9%和92.0%,阳性预测值和阴性预测值分别为61.11%和95.86%。逐步回归统计分析,Alb、PLT、AST、年龄、体质量对Stiffness值有影响。结论 Fibroscan评估CHB患者肝纤维化程度尤其是显著肝纤维化和肝硬化准确性高,在诊断与疗效评估中具有较好的应用价值。     

慢性乙肝患者肝脏CT检查与肝穿病理改变的对照研究

目的 了解肝脏CT检查对早期肝硬化的诊断价值及其与肝纤维化程度的相关性.方法 152例慢性乙型病毒性肝炎患者经皮肝脏穿刺活检术行病理组织学检查,同时行肝脏CT检查,测量肝脾CT值、门静脉及脾静脉宽度及脾脏大小.结果 152例患者中肝活检显示37例为早期肝硬化,CT检查33例为早期肝硬化,提示CT对早期肝硬化诊断的诊断灵敏度81.08%,特异度90.91%,误诊率9.09%,漏诊率18.91%.结论 肝脏CT检查对早期肝硬化的诊断灵敏度较高,可以作为慢性乙型肝炎患者的常规检查项目,从而有助于早期肝硬化的诊断,并指导积极抗病毒治疗.     

FibroScan评估酒精性肝病肝纤维化程度的诊断价值

目的探讨瞬时弹性成像技术(FibroScan)在评估酒精性肝病肝纤维化程度中的应用价值。方法对60例酒精性肝病患者采用FibroScan测量肝脏硬度,获得FibroScan弹性值(FS值),同时对患者进行肝活组织检查.以病理结果为金标准,分析FS值与酒精性肝纤维化分期的相关性。用受试者工作特征(receiver operatmg charateristic,R()C)曲线评估FibroScan对酒精性肝病的诊断价值。结果酒精性肝病患者肝纤维化分期S0~S4的FS值分别为S0:(5.31±1.06)kPa、S1:(7.91±2.81)kPa、S2:(9.81±3.39)kPa、S3:(14.66±4.31)kPa、S4:(19.81±6.02)kPa。组间差异有统计学意义(P0.(5)。进一步分析显示FS值与肝纤维化分期呈正相关性(r=0.706,P0.05)。肝纤维化程度≥S1、≥S2、≥S3和S4的ROC曲线下面积分别为0.833、0.871、0.906和0.919。结论 Fibroscan作为一种无创技术,能够较准确地定量评估酒精性肝病肝纤维化程度。     

Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases

A proper diagnosis of cirrhosis is essential for the management of patients with chronic liver diseases. We assessed the accuracy of liver stiffness measurement by Fibroscan for the diagnosis of cirrhosis in 1,257 patients with chronic liver diseases of various causes enrolled in a prospective multicenter study as well as clarified causes of discrepancies between liver histology and Fibroscan. One hundred thirty-two patients had unsuitable biopsy specimens, and 118 had unreliable liver stiffness measurements. Because 232 patients overlapped with a previous study, analysis was performed in the 775 new patients then derived in the whole population (1,007; 165 cirrhosis). Diagnostic accuracy was assessed by receiver operator curve (ROC) analysis. Liver samples were re-analyzed in case of discrepancies. The area under the ROC (AUROC) was 0.95 (95% CI, 0.93-0.96) for the diagnosis of cirrhosis in either 775 or 1,007 patients. The cutoff value with optimal diagnosis accuracy was 14.6 kPa in 1,007 patients (positive and negative predictive values, 74% and 96%) with discrepancies among the etiological groups. Eighty patients were misclassified: (1) among 45 patients without cirrhosis with liver stiffness 14.6 kPa or greater, 27 (60%) had extensive fibrosis and 10 (22%) significant perisinusoidal fibrosis; and (2) among 35 patients with cirrhosis and liver stiffness less than 14.6 kPa, 10 (29%) had a macronodular pattern and 25 (71%) either none or mild activity. In conclusion, Fibroscan is a reliable method for the diagnosis of cirrhosis in patients with chronic liver diseases, better at excluding than at predicting cirrhosis using a threshold of 14.6 kPa. False-negatives are mainly attributable to inactive or macronodular cirrhosis.     

Previously unrecognized advanced liver disease unveiled by transient elastography in patients with Haemophilia and chronic hepatitis C

Summary. Before the introduction of viral inactivation procedures and viral screening of plasma‐products, haemophiliacs were at high risk of infection with HCV. Those who acquired HCV infection in the 1980s, and are still alive today, may have developed significant liver fibrosis or cirrhosis. However, liver biopsy has not routinely been utilized in the evaluation of haemophiliacs with HCV in Denmark. The aim of this study was to investigate the prevalence of significant fibrosis/cirrhosis among haemophiliacs as evaluated by transient elastography (TE). Cross‐sectional investigation of adult patients with haemophilia A or B. TE with liver stiffness measurements (LSM) ≥8 kPa were repeated after 4–6 weeks. Significant fibrosis and cirrhosis was defined as measurements ≥8 kPa or ≥12 kPa respectively. Among 307 patients with haemophilia A or B registered at the two Haemophilia centres, 141(46%) participate in this study. Forty (28.4%) had chronic hepatitis C, 33 (23.4%) past hepatitis C and 68 (48.2%) had never been infected, at screening LSM ≥8 kPa were found in 45.7%, 24.7% and 4.6% respectively. Among patients with chronic hepatitis C significant fibrosis was confirmed in 17.1% and cirrhosis in 2.9% by repeated LSM ≥8 and ≥12 kPa respectively. The median TE‐value in never HCV‐infected haemophiliacs was comparable with what has been found in healthy non‐haemophiliacs. In Danish haemophiliacs where liver biopsy has not routinely been used for assessing severity of liver fibrosis, LSM identified advanced liver disease in one‐fifth of cases that had not been recognized during clinical follow‐up.     

The use of transient elastometry for assessing liver fibrosis in patients with HIV and hepatitis C virus coinfection.

BACKGROUND: Transient elastometry (TE) is accurate for detecting significant liver fibrosis and cirrhosis in hepatitis C virus (HCV)-monoinfected patients. However, this procedure has been insufficiently validated in patients with human immunodeficiency virus (HIV) and HCV coinfection. The purpose of this study was to validate reported cutoff values of TE that discriminate significant liver fibrosis and cirrhosis in HIV-HCV-coinfected subjects. METHODS: Liver stiffness measurements were obtained for 169 HIV-HCV-coinfected adult patients who had undergone a liver biopsy or who had received a nonhistologic diagnosis of cirrhosis within 12 months before or after a liver stiffness measurement. Patients had received no prior therapy for HCV infection. RESULTS: TE measurements ranged from 3.6 kPa to 75 kPa. The area under the receiver operating characteristic curve was 0.87 (95% confidence interval, 0.84-0.93) for significant liver fibrosis and 0.95 (95% confidence interval, 0.92-0.99) for cirrhosis. To diagnose significant liver fibrosis, a cutoff value of 7.2 kPa was associated with a positive predictive value of 88% and a negative predictive value of 75%. Thirty-four patients (20%) were misclassified when this cutoff value was used. Thirteen (24%) of 54 patients with liver stiffness values <7.2 kPa had significant liver fibrosis detected by liver biopsy. To diagnose cirrhosis, a cutoff value of 14.6 kPa was associated with a positive predictive value of 86% and a negative predictive value of 94%. Thus, 13 patients (10%) had disease that was misclassified using this cutoff value. CONCLUSIONS: We found that the diagnostic accuracy of TE was high for detecting cirrhosis and good for diagnosis of significant liver fibrosis. However, the performance of TE was low for discriminating mild fibrosis from significant liver fibrosis, which might limit the applicability of this technique in clinical practice.     

Outreach screening of drug users for cirrhosis with transient elastography

Aims Transient elastography (TE) is a non‐invasive sensitive tool for diagnosing cirrhosis in hospital‐based cohorts. This study aimed to evaluate TE as a screening tool for cirrhosis among drug users. Design Cross‐sectional study. Setting All treatment centres in the county of Funen, Denmark. Participants Drug users attending treatment centres during the presence of the study team. Measurements Liver stiffness measurements (LSM) by transient elastography using the Fibroscan device; blood tests for viral hepatitis, HIV infection and hyaluronic acid (HA) levels; and routine liver tests. Individuals with LSM ≥ 8 kPa were referred to the hospital for treatment evaluation. Individuals with LSM ≥ 12 kPa were recommended a liver biopsy. Findings Among 175 drug users negative for hepatitis C, 13% had LSM = 8–11.9 kPa and 4% had LSM ≥ 12 kPa; elevated LSM was associated with a body mass index (BMI) > 30. Among 128 drug users with chronic hepatitis C, 19.5% had LSM = 8–11.9 kPa and 21.1% had LSM ≥ 12 kPa (P < 0.001). Repeat LSM at liver biopsy performed a median 3 months after screening showed a significant decrease (<12 kPa) among 30% (six of 20), and this was independent of alcohol consumption, BMI, age and gender. In 29 patients where liver biopsy was performed a LSM ≥ 16 kPa predicted cirrhosis with 88.9% sensitivity and 90% specificity. Conclusions Transient elastography is a feasible screening tool for cirrhosis among drug users. Transient elastography identifies severe liver fibrosis in a significant proportion of drug users with hepatitis C infections but management should not be based on a single elevated liver stiffness measurement.     

Transient elastography for the noninvasive assessment of liver fibrosis: a multicentre Canadian study

BACKGROUND

Liver stiffness measurement (LSM) using transient elastography (TE) is a promising tool for the noninvasive assessment of hepatic fibrosis.

OBJECTIVES

To determine the feasibility and performance of TE in a North American cohort of patients with chronic liver disease.

METHODS

LSMs were obtained using TE in 260 patients with chronic hepatitis B or C, or nonalcoholic fatty liver disease from four Canadian hepatology centres. The accuracy of TE compared with liver biopsy for the prediction of significant fibrosis (Metavir fibrosis score of F2 or greater), bridging fibrosis (Metavir fibrosis score of F3 or greater) and cirrhosis (Metavir fibrosis score of F4 ) was assessed using area under ROC curves (AUROCs), and compared with the aspartate aminotransferase-to-platelet ratio index. The influence of alanine aminotransferase (ALT) levels and other factors on liver stiffness was determined using linear regression analyses.

RESULTS

Failure of TE occurred in 2.7% of patients, while liver biopsies were inadequate for staging in 0.8%. Among the remaining 251 patients, the AUROCs of TE for Metavir fibrosis scores of F2 and F3 or greater, and F4 were 0.74 (95% CI 0.68 to 0.80), 0.89 (95% CI 0.84 to 0.94), and 0.94 (95% CI 0.90 to 0.97), respectively. LSM was more accurate than the aminotransferase-to-platelet ratio index for bridging fibrosis (AUROC 0.78) and cirrhosis (AUROC 0.88), but not significant fibrosis (AUROC 0.76). At a cut-off of 11.1 kPa, the sensitivity, specificity, and positive and negative predictive values for cirrhosis (prevalence 11%) were 96%, 81%, 39% and 99%, respectively. For significant fibrosis (prevalence 53%), a cut-off of 7.7 kPa was 68% sensitive and 69% specific, and had a positive predictive value of 70% and a negative predictive value of 65%. Liver stiffness was independently associated with ALT, body mass index and steatosis. The optimal LSM cut-offs for cirrhosis were 11.1 kPa and 11.5 kPa in patients with ALT levels lower than 100 U/L and 100 U/L or greater, respectively. For fibrosis scores of F2 or greater, these figures were 7.0 kPa and 8.6 kPa, respectively.

CONCLUSIONS

The major role of TE is the exclusion of bridging fibrosis and cirrhosis. However, TE cannot replace biopsy for the diagnosis of significant fibrosis. Because liver stiffness may be influenced by significant ALT elevation, body mass index and/or steatosis, tailored liver stiffness cut-offs may be necessary to account for these factors.     

Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis

Transient elastography (FibroScan [FS]) is a novel non-invasive tool to assess liver fibrosis/cirrhosis. However, it remains to be determined if other liver diseases such as extrahepatic cholestasis interfere with fibrosis assessment because liver stiffness is indirectly measured by the propagation velocity of an ultrasound wave within the liver. In this study, we measured liver stiffness immediately before endoscopic retrograde cholangiopancreatography and 3 to 12 days after successful biliary drainage in patients with extrahepatic cholestasis mostly due to neoplastic invasion of the biliary tree. Initially elevated liver stiffness decreased in 13 of 15 patients after intervention, in 10 of them markedly. In three patients, liver stiffness was elevated to a degree that suggested advanced liver cirrhosis (mean, 15.2 kPa). Successful drainage led to a drop of bilirubin by 2.8 to 9.8 mg/dL whereas liver stiffness almost normalized (mean, 7.1 kPa). In all patients with successful biliary drainage, the decrease of liver stiffness highly correlated with decreasing bilirubin (Spearman's rho = 0.67, P < 0.05) with a mean decrease of liver stiffness of 1.2 +/- 0.56 kPa per 1 g/dL bilirubin. Two patients, in whom liver stiffness did not decrease despite successful biliary drainage, had advanced liver cirrhosis and multiple liver metastases, respectively. The relationship between extrahepatic cholestasis and liver stiffness was reproduced in an animal model of bile duct ligation in landrace pigs where liver stiffness increased from 4.6 kPa to 8.8 kPa during 120 minutes of bile duct ligation and decreased to 6.1 kPa within 30 minutes after decompression. Conclusion: Extrahepatic cholestasis increases liver stiffness irrespective of fibrosis. Once extrahepatic cholestasis is excluded (e.g., by liver imaging and laboratory parameters) transient elastography is a valuable tool to assess liver fibrosis in chronic liver diseases.     

Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B

Summary.  The aim of this study is to know the liver stiffness measurement (LSM) cutoffs for different stages of liver fibrosis in chronic hepatitis B (CHB) and to investigate the effect of alanine aminotransferase (ALT) on LSM. We prospectively studied consecutive CHB patients undergoing liver biopsy and transient elastography examinations. Diagnostic performance of LSM for different degrees of liver fibrosis was evaluated. One hundred and sixty-one CHB patients with adequate liver biopsy sample size were studied. Area under receiver operating characteristics curves of LSM for no fibrosis (F0 vs F1–4), bridging fibrosis (F0–2 vs F3–4) and liver cirrhosis (F0–3 vs F4) was 0.80 (95% CI: 0.68–0.92), 0.87 (95% CI: 0.82–0.93) and 0.93 (95% CI: 0.89–0.97) respectively. For liver cirrhosis, these optimal cutoff values were 8.4 kPa (98% sensitivity), 9.0 kPa (maximum sum of sensitivity and specificity), 13.4 kPa (94% specificity) and 13.4 kPa (maximum diagnostic accuracy, 85%) respectively. Patients with the same fibrosis staging but higher ALT levels tend to have higher LSM, and the diagnostic performance for low stage fibrosis was most seriously affected when ALT was elevated. Different LSM cutoff values and algorithms were derived for normal and elevated ALT levels. Based on these algorithms, liver biopsy can be avoided in 62% and 58% of patients with normal and elevated ALT respectively. In conclusion, transient elastography is a reasonable noninvasive tool to substitute liver biopsy among the lowest and highest risk patients for the assessment of liver fibrosis.     

Usefulness of transient elastography for assessment of liver fibrosis in chronic hepatitis B: Regression of liver stiffness during entecavir therapy

Aim: The usefulness of transient elastography remains to be validated in chronic hepatitis B, particularly as a tool for monitoring the degree of liver fibrosis during treatment. Methods: The subjects were 50 patients with chronic hepatitis B virus infection. Liver biopsy was performed in 38 patients, and in 12 patients with platelet counts of 50 × 10⁹/L or less, cirrhosis was clinically diagnosed on the basis of specific signs of portal hypertension. Liver stiffness was measured by transient elastography at baseline and after 12 months of treatment in 20 nucleos(t)ide‐naïve patients who started entecavir within 3 months after study entry. Results: Twenty (40%) patients were classified as F1, 10 (20%) as F2, 5 (10%) as F3, and 15 (30%) as F4 (cirrhosis). Median liver stiffness (interquartile range) was 7.0 kPa (5.6–9.4), 9.8 kPa (5.6–14.7), 9.8 kPa (7.6–12.9), and 17.3 kPa (8.2–27.6) in fibrosis stages F1 to F4, respectively. Liver stiffness significantly correlated with fibrosis stage (r = 0.46; P = 0.0014). Of the patients who started entecavir, median liver stiffness significantly decreased from 11.2 kPa (7.0–15.2) to 7.8 kPa (5.1–11.9; P = 0.0090) during 12 months of treatment. Median levels of amino‐terminal peptide of type III procollagen and type IV collagen 7S domain in serum significantly decreased from 0.9 (0.6–1.3) to 0.6 (0.5–0.7) U/mL (P = 0.0010) and from 5.0 (4.4–6.7) to 3.9 (3.2–4.4) ng/mL (P = 0.015), respectively. Conclusion: Liver stiffness measurement can be useful for monitoring regression of liver fibrosis during entecavir treatment in patients with chronic hepatitis B virus infection.     

Comparison of liver biopsy and transient elastography based on clinical relevance

BACKGROUND: Liver stiffness measurement (LSM) by transient elastography has recently been validated for the evaluation of liver fibrosis in chronic liver diseases. The present study focused on cases in which liver biopsy and LSM were discordant. METHODS: Three hundred eighty-six patients with chronic hepatitis C who underwent a liver biopsy between December 2004 and April 2007 were studied. First, the optimal cut-off value of LSM was selected for the determination of cirrhosis based on the receiver operating characteristic curve. Then, the cases in which liver histology and evaluation by LSM were discordant were selected. Laboratory test results such as serum total bilirubin concentration, prothrombin activity, albumin concentration, platelet count and the aspartate aminotransferase to platelet ratio index, together with the presence of esophageal varices, were analyzed. RESULTS: The optimal cut-off value was chosen to be 15.9 kPa for cirrhosis (fibrosis stage [F] 4) determination to maximize the sum of sensitivity (78.9%) and specificity (81.0%). There were 78 discordant cases: 51 patients showed an LSM of 15.9 kPa or higher and a fibrosis stage of F1 to F3 (high LSM group), and 27 patients had an LSM lower than 15.9 kPa and a fibrosis stage of F4 (low LSM group). Esophageal varices were seen in 11 patients in the high LSM group (n=51) and in no patients in the low LSM group (n=27) (P=0.0012). The aspartate aminotransferase to platelet ratio index was significantly higher in the high LSM group (1.49 versus 0.89, P=0.019). Other parameters did not differ significantly. However, platelet count, prothrombin activity and albumin concentration tended to be lower in the high LSM group. CONCLUSIONS: Patients with a high LSM need proper attention for cirrhosis, even if liver biopsy does not reveal cirrhosis.