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。     

Non-invasive assessment of liver fibrosis by transient elastography in post transfusional iron overload

Background: Liver fibrosis, assessed by biopsy, is the main complication of post transfusional liver iron overload. Transient elastography (TE) is a new, non invasive method able to measure liver stiffness (LS) caused by fibrosis. Method: We prospectively evaluated the predictive value of LS measurement for liver fibrosis evaluation in 15 chronically transfused patients and compared these results with the METAVIR histological fibrosis stage from liver biopsies. Results: Mean TE values significantly differed in patients with severe fibrosis (METAVIR F3, F4): 9.1 (±3.7 SD) kPa from those with mild or no fibrosis (METAVIR F0, F1, F2): 5.9 (±1.8 SD) kPa (P = 0.046). TE value above 6.25 kPa (Se = 80%; Sp = 70%; AUROC = 0.820) identified patients at risk for severe fibrosis (Negative Predictive Value 88%; Positive Predictive Value 57%). Conclusion: Transient elastography appears to be a reliable tool to evaluate liver fibrosis in post‐transfusional iron overload.     

Performance of liver stiffness measurements by transient elastography in chronic hepatitis

AIM:To compare results of liver stiffness measurements by transient elastography(TE) obtained in our patients population with that used in a recently published meta-analysis.METHODS:This was a single center cross-sectional study.Consecutive patients with chronic viral hepatitis scheduled for liver biopsy at the outpatient ward of our Infectious Diseases Department were enrolled.TE was carried out by using FibroScan(Echosens,Paris,France).Liver biopsy was performed on the same day as TE,as day case procedure.Fibrosis was staged according to the Metavir scoring system.The diagnostic performance of TE was assessed by using receiver operating characteristic(ROC) curves and the area under the ROC curve analysis.RESULTS:Two hundred and fifty-two patients met the inclusion criteria.Six(2%) patients were excluded due to unreliable TE measurements.Thus,246(171 men and 75 women) patients were analyzed.One hundred and ninety-five(79.3%) patients had chronic hepatitis C,41(16.7%) had chronic hepatitis B,and 10(4.0%) were coinfected with human immunodeficiency virus.ROC curve analysis identified optimal cut-off value of TE as high as 6.9 kPa forF ≥ 2;7.9 kPa forF ≥ 3;9.6 kPa for F = 4 in all patients(n = 246),and as high as 6.9 kPa for F ≥ 2;7.3 kPa for F ≥ 3;9.3 kPa for F = 4 in patients with hepatitis C(n = 195).Cut-off values of TE obtained by maximizing only the specificity were as high as 6.9 kPa for F ≥ 2;9.6 kPa for F ≥ 3;12.2 kPa for F = 4 in all patients(n = 246),and as high as 7.0 kPa forF ≥ 2;9.3 kPa forF ≥ 3;12.3 kPa forF = 4 in patients with hepatitis C(n = 195).CONCLUSION:The cut-off values of TE obtained in this single center study are comparable to that obtained in a recently published meta-analysis that included up to 40 studies.     

瞬时弹性检测技术在肝脏疾病诊断中的应用

目前,瞬时弹性检测肝脏疾病得到了广泛应用。越来越多的学者发现合理应用该技术能够帮助无创诊断肝纤维化、监测治疗效果及预估病情。本文主要介绍了该技术的原理、应用、影响因素及前景等方面的研究进展。     

瞬时弹性成像技术在慢性肝病肝纤维化诊断中的应用进展

肝脏纤维化程度及进展与慢性肝脏疾病的诊断与治疗密切相关。早期诊断肝纤维化程度有助于避免代偿期患者向肝硬化失代偿期发展,也有助于降低肝细胞癌的发生率。目前,临床上评估肝纤维化程度的“金标准”仍为肝脏穿刺活检,但是由于其操作的有创性,以及穿刺后可能出现的多种并发症等多种因素的影响,限制了它在临床研究中的使用。瞬时弹性成像技术无创、安全、有利于动态监测肝纤维化进展、客观评价肝脏纤维化程度,使其在国内外得到了广泛的认同,在临床上具有良好的应用前景。     

肝组织纤维化分期的纤维定量分析与血清肝纤维化标志物关系的研究

目的研究肝组织纤维化分期的纤维定量分析与血清肝纤维化标志物的关系。方法对７７例慢性肝病患者网状、胶原及弹力纤维面积进行真彩图像定量并分析其与血清肝纤维化标志物的相关关系。结累随慢性肝病分期从Ｓ０到Ｓ４,肝组织三种纤维均逐步升高,尤其胶原纤维最明显,Ｓ３与Ｓ２组比、Ｓ２与Ｓ１组及Ｓ１与Ｓ０组比,差异均有显著性;血清肝纤维化标志物与胶原纤维面积相关系数依次为透明质酸（ＮＡ）０．７０７７５＞ＩＶ型胶原（ＣＩＶ）０５９４０２＞层粘连蛋白（ＬＮ）０．５２５９３＞Ⅲ型前胶原（ｈＰＣⅢ）０．５２１９８。结论血清肝纤维化标志物对辅助诊断肝纤维化有肯定的价值。     

Comparison of the liver stiffness measurement by transient elastography with the liver biopsy

AIM： To compare the liver stiffness （LS） measurement by transient elastography （TE） to the liver biopsy （LB）considered the ＂gold standard＂ in the evaluation of patients with chronic hepatitis C. METHODS： During a period of 12 mo, we evaluated 199 consecutive patients with chronic hepatitis due to hepatitis C virus （HCV）, in which LB and LS assessments （by means of TE） were performed during the same session. RESULTS： Out of 199 patients, a valid measurement of the LS could not be obtained in 8. The mean value of LS in the cohort of 191 valid measurements was 8.45 ± 4.96 kPa, ranging from 2.3 to 38 kPa. The mean value of LS in patients with significant fibrosis at biopsy （161 patients with F ≥ 2 according to Metavir） was 9.02 ± 5.15 kPa, significantly higher than in patients with no or mild fibrosis （30 patients with F 〈 2 Metavir）： 5.39 ± 1.81 kPa （P 〈 0.0001）. For a cutoff value of 6.8 kPa, the LS had a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6% and a specificity of 93.3% for the presence of significant fibrosis （at least F2 Metavir）, with a diagnostic performance of 77.3% （AUROC 0.773）. Using this cut-off value, we reached the best discrimination between absence of fibrosis/ mild fibrosis （F 〈 2 Metavir） and the presence ofmoderate to severe fibrosis （F ≥ 2 Metavir）. CONCLUSION： In patients with chronic hepatitis due to HCV, a cut-off value of 6.8 kPa measured by TE can differentiate between significant fibrosis and absent or mild fibrosis, with a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6%, a specificity of 93.3%, and a diagnostic performance of 77.3%.     

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。     

瞬时弹性成像技术诊断肝纤维化专家意见

基于肝脏瞬时弹性成像技术(transient elastography,TE)的Fibroscan能够通过检测肝脏硬度值(liver stiffness measurement,LSM)来判断肝纤维化,TE诊断肝炎肝硬化的效能优于FibroTest、 FibroMeter、 HepaScore、APRI、API、FIB-4、Forns指数、Hui指数、代偿性肝硬化指数(CCD等血清生物学标志物[1-7],在我国已被批准用于临床.为促进这一技术在临床上的正确合理应用,中国肝炎防治基金会组织专家撰写了《瞬时弹性成像技术诊断肝纤维化专家意见》,并在郑州召开讨论会进一步修改、定稿.随着临床实践的进展及证据积累,专家委员会将对本意见作进一步完善.     

肝脏瞬时弹性成像和血清肝纤维化指标对肝移植术后肝纤维化的诊断价值研究

目的评价肝脏瞬时弹性成像(FibroScan)及血清肝纤维化4项[透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)和血清Ⅲ型前胶原(PCⅢ)]对肝移植患者发生明显肝纤维化(F2)的诊断价值。方法选择2013年2月28日一2014年7月8日在本院治疗的行经皮肝脏穿刺活体组织检查的肝移植和非肝移植慢性肝病患者各40例,进行FibroScan检查以及血清肝纤维化4项检测。将肝脏硬度测定(liver stiffness measurement,LSM)值和血清肝纤维化4项结果与病理检查的肝纤维化程度进行相关性分析,用受试者工作特征曲线(receiver-operating characteristic curve,ROC曲线)分析和评估LSM值和血清肝纤维化4项对肝移植患者明显肝纤维化的诊断价值。结果肝移植患者HA和LSM值与肝纤维化评分呈正相关,r_s分别为0.689和0.782。HA和LSM值诊断肝移植患者明显纤维化的ROC曲线下面积分别为0.789和0.943。明显肝纤维化患者中,肝移植者的LSM值高于非肝移植患者(P0.05);无明显肝纤维化(F≤2)的患者中,肝移植者Ⅳ-C和PCⅢ低于非肝移植患者(P均0.05)。结论 LSM值和血清HA与肝移植患者的肝纤维化评分呈正相关,它们对肝移植患者的明显肝纤维化具有一定的诊断价值。     

Comparison of FibroTouch and FibroScan for staging fibrosis in chronic liver disease: Single-center prospective study

BackgroundThe aim of this study was to compare the diagnostic accuracy of the FibroTouch and FibroScan in patients with chronic liver disease (CLD) for staging fibrosis.MethodsA prospective study was conducted in 435 CLD patients between 2014 and 2017. Index tests (FibroTouch, FibroScan, APRI, and FIB-4 score) and a reference standard (liver biopsy) were performed within one week.ResultsThe area under the receiver operating curve (AUROC) of the FibroTouch was similar with that of the FibroScan for the diagnosis of significant fibrosis, severe fibrosis, or cirrhosis; however, the AUROC of the FibroTouch was higher than that of APRI or FIB‐4 (p < 0.001). There was a significant correlation (rho = 0.85, p < 0.001) between the FibroTouch and FibroScan for liver stiffness. The overall diagnostic accuracy of FibroTouch for significant fibrosis, severe fibrosis, or cirrhosis was 73.3%, 83.2%, or 84.1%, respectively. No significant differences between the FibroTouch and FibroScan were detected regarding the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy. The optimal cut-off values for each stage of fibrosis were similar between the FibroTouch and FibroScan.ConclusionThe FibroTouch is a valuable diagnostic tool for diagnosing liver fibrosis with good diagnostic accuracy which was comparable with that of the FibroScan, but superior to that of the APRI and FIB-4.     

Effect of alcohol consumption on liver stiffness measured by transient elastography

AIM:To determine the evolution of transient elastography(TE) in patients with alcoholic liver disease according to alcohol cessation or continuation.METHODS:We retrospectively selected in our local database all patients who had two TE between June 2005 and November 2010 with chronic alcohol excessive consumption and excluded those with associated cause of liver disease.TE was performed at least one week apart by senior operator.TE examinations with less than ten successful measures or with an interquartile range above 30% were excluded.We retrospectively reviewed file of all patients to include only patient followed up by trained addictologist and for which definite information on alcohol consumption was available.Concomitant biological parameters [aspartate amino transferase(AST),alanine amino transferase and gamma-glutamyl transpeptidase(GGT)] within 4 wk of initial and final TE were recorded.Putative fibrosis score according to initial and final TE were determined with available cut-off for alcoholic liver disease and hepatitis C.Initial and final putative fibrosis score were compared according to alcohol consumption during follow-up.RESULTS:During the study period 572 patients had TE examination for alcoholic liver disease and 79 of them had at least two examinations.Thirty-seven patients met our criteria with a median follow-up of 32.5 wk.At the end of the study,13(35%) were abstinent,and 24(65%) relapsers.Eight patients had liver biopsy during follow-up.TE decreased significantly during follow-up in 85% of abstinent patients [median(range):-4.9(-6.1,-1.9)],leading to a modification of the putative fibrosis stage in 28%-71% of patient according to different cut-off value.In relapsers TE increased in 45% and decreased in 54% of patient.There was no statistical difference between initial and final TE in relapsers.In the overall population,using 22.6 kPa as cut-off for cirrhosis,4 patients had cirrhosis at initial TE and 3 patients had cirrhosis at final TE.Using 19.5 kPa as cut-off for cirrhosis,7 patients ha     

从常规指标中建立肝纤维化非创伤性诊断模型

目的在慢性乙型肝炎病毒（HBV）感染患者中建立基于常规实验室指标的肝纤维化非创伤性诊断模型,为传统的肝穿刺活检提供简便的非创伤性替代手段。方法采用Logistic回归等方法分析386例慢性HBV感染患者的常规实验室指标与肝纤维化分期的关系,建立诊断模型。用受试者工作曲线（ROC）等方法验证和比较该模型与Forns指数、APRI指数、Hepascore及SLFG模型的诊断价值。结果各指标组合模型对肝纤维化分期的诊断价值优于单项常规实验室指标,其中SLFG模型、S指数和Hepascore均具有较好的表现。由γ-谷氨酰转肽酶（GGT）、血小板（PLT）和白蛋白（Alb）三个常规指标组成的S指数（S指数=1000×GGT/（PLT×Alb2））判断有无明显肝纤维化和有无早期肝硬化时的受试者工作曲线下面积（AUC）分别达到0.686和0.762。使用以下推荐界值,S指数〈0.1预测无明显肝纤维化的灵敏度为90.4%,S指数≥0.5预测存在明显肝纤维化的特异度为86.2%;S指数〈0.3预测无早期肝硬化的灵敏度为84.8%,S指数≥1.5预测存在早期肝硬化的特异度为97.7%。结论由常规实验室指标建立的简单组合S指数,能较准确而方便地区分存在明显肝纤维化或早期肝硬化的慢性HBV感染患者。     

Performance and utility of transient elastography and noninvasive markers of liver fibrosis in primary biliary cirrhosis

Background

The performance of transient elastography in primary biliary cirrhosis has yet to be fully established.

Aim

To assess: (1) the performance of transient elastography in identifying significant fibrosis in primary biliary cirrhosis by comparison with surrogate markers (AST platelet ratio index (APRI), FIB-4, Fibroindex, Forns, aspartate aminotransferase/alanine aminotransferase ratio); (2) the correlation between liver stiffness and Mayo score prognostic index.

Methods

One hundred and twenty patients with primary biliary cirrhosis were consecutively enrolled. The performance of each marker and of liver stiffness was compared with histological staging and METAVIR at time of liver biopsy.

Results

The area under receiver operating characteristic (ROC) of liver stiffness were 0.87, 0.88, 0.99 for histological stage ≥II, ≥III and =IV and 0.89, 0.92, 0.99 for METAVIR ≥2, ≥3 and =4. Transient elastography alone proved better able in identifying any grade of fibrosis or cirrhosis than noninvasive markers. Combining each surrogate marker with transient elastography did not improve the area under ROC. Transient elastography correlated positively with the Mayo score (P < 0.001). Logistic regression analysis showed that transient elastography was associated with an advanced fibrosis (P < 0.001).

Conclusions

Transient elastography proved a simple, reliable and useful method for assessing liver fibrosis in primary biliary cirrhosis, whereas noninvasive surrogate markers proved unsatisfactory in predicting significant fibrosis.     

Assessment of biopsy proven liver fibrosis by two-dimensional shear wave elastography in patients with primary biliary cholangitis

BackgroundTwo-dimensional shear-wave elastography (2D-SWE) is an ultrasound-based technique used to stage liver fibrosis by measuring liver stiffness (LS). The diagnostic performance of 2D-SWE for assessing liver fibrosis in patients with primary biliary cholangitis (PBC) has not been reported before.AimsTo investigate the diagnostic performance of 2D-SWE for staging liver fibrosis in patients with PBC by using histologic analysis as a reference standard.MethodsPatients with PBC who underwent liver biopsy and 2D-SWE were retrospectively collected. Liver fibrosis was staged according to the Scheuer scoring system. Areas under receiver operating characteristic curve (AUROC) was constructed to assess the accuracy of 2D-SWE and serum fibrosis models for staging liver fibrosis.ResultsThe diagnostic performance characteristics were determined for 157 patients with PBC. The AUROCs of LS measured by 2D-SWE for significant fibrosis, severe fibrosis, and cirrhosis were 0.88, 0.97 and 0.99, respectively. The cutoff values of LS measured by 2D-SWE in discriminating significant fibrosis, severe fibrosis, and cirrhosis were 10.7 kPa, 12.2 kPa and 14.1 kPa, respectively. The diagnostic accuracy of 2D-SWE for staging liver fibrosis was 73.9%.Conclusions2D-SWE is an efficient noninvasive method for the assessment of liver fibrosis in patients with PBC.