Diagnosis of cirrhosis by transient elastography (FibroScan):: a prospective study
Diagnosis of cirrhosis by transient elastography (FibroScan):: a prospective study
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DOI：
10.1136/gut.2005.069153
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发表时间：
2006-03-01
期刊：
影响因子：
24.5
通讯作者：
de Lédinghen, V
中科院分区：
文献类型：
--
作者：
Foucher, J;Chanteloup, E;de Lédinghen, V
背景资料：瞬时弹性成像（FibroScan）是一种新的、无创的、快速的、可重复的方法，可以通过测量肝脏硬度来评估肝纤维化。在肝硬化患者中，肝硬度测量值范围为12.5至75.5 kPa。然而，这些数值的临床相关性尚不清楚。本前瞻性研究的目的是评估肝硬度测量的准确性检测肝硬化的慢性肝病patients with chronic liver disease.Methods：共711例慢性肝病患者进行了研究。慢性肝病的病因为丙型肝炎病毒或B型肝炎病毒感染、酒精、非酒精性脂肪性肝炎、其他或上述病因的组合。结果：肝硬化程度与肝纤维化分期有显著相关性（r = 0.73，p < 0.0001）。显著纤维化患者的受试者工作特征曲线下面积（95%置信区间）为0.80（0.75-0.84）（F > 2），严重纤维化患者为0.90（0.86-0.93）（F3），肝硬化患者为0.96（0.94-0.98）。使用17.6 kPa的截止值，检测到肝硬化患者的阳性预测值和阴性预测值（NPV）均为90%。肝硬度与肝病的临床、生物学和形态学参数显著相关。当NPV > 90%时，食管静脉曲张2/3期、肝硬化Child-Pugh B或C级、腹水既往史、肝细胞癌和食管出血的临界值分别为27.5、37.5、49.1、53.7和62.7 kPa。瞬时弹性成像是一种很有前途的非侵入性方法，用于检测慢性肝病患者的肝硬化。其用于这些患者的随访和管理可能具有很大的意义，应进一步评估。
Background: Transient elastography (FibroScan) is a new, non-invasive, rapid, and reproducible method allowing evaluation of liver fibrosis by measurement of liver stiffness. In cirrhotic patients, liver stiffness measurements range from 12.5 to 75.5 kPa. However, the clinical relevance of these values is unknown. The aim of this prospective study was to evaluate the accuracy of liver stiffness measurement for the detection of cirrhosis in patients with chronic liver disease.Methods: A total of 711 patients with chronic liver disease were studied. Aetiologies of chronic liver diseases were hepatitis C virus or hepatitis B virus infection, alcohol, non-alcoholic steatohepatitis, other, or a combination of the above aetiologies. Liver fibrosis was evaluated according to the METAVIR score.Results: Stiffness was significantly correlated with fibrosis stage (r = 0.73, p < 0.0001). Areas under the receiver operating characteristic curve (95% confidence interval) were 0.80 (0.75-0.84) for patients with significant fibrosis (F > 2), 0.90 (0.86-0.93) for patients with severe fibrosis (F3), and 0.96 (0.94-0.98) for patients with cirrhosis. Using a cut off value of 17.6 kPa, patients with cirrhosis were detected with a positive predictive value and a negative predictive value (NPV) of 90%. Liver stiffness was significantly correlated with clinical, biological, and morphological parameters of liver disease. With an NPV > 90%, the cut off values for the presence of oesophageal varices stage 2/3, cirrhosis Child-Pugh B or C, past history of ascites, hepatocellular carcinoma, and oesophageal bleeding were 27.5, 37.5, 49.1, 53.7, and 62.7 kPa, respectively.Conclusion: Transient elastography is a promising non-invasive method for detection of cirrhosis in patients with chronic liver disease. Its use for the follow up and management of these patients could be of great interest and should be evaluated further.