Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases
Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases
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DOI：
10.1111/j.1365-2893.2006.00811.x
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发表时间：
2007-05-01
影响因子：
2.5
通讯作者：
Brunetto, M. R.
中科院分区：
文献类型：
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作者：
Coco, B.;Oliveri, F.;Brunetto, M. R.
应用瞬时弹性成像技术(FibroScan(R))测定了228例慢性病毒性肝炎患者的肝硬化度，以探讨其与血清转氨酶[丙氨酸氨基转移酶(ALT)]、肝纤维化分期及替代的非侵入性肝纤维化标志物(APRI、Forns、FibroTest和透明质酸)的相关性。31例患者在6个月的随访中，通过多项检测比较了血清转氨酶和肝脏硬度的动态变化。我们将8.3和14kpa分别确定为纤维化和肝硬变的界值：敏感度为85.2%/78.3%；特异度为90.7%/98.2%；阳性预测值为93.9%/97.8%；阴性预测值为78.8%/81.6%；诊断准确率为87.3%/88.2%。纤维扫描((R))比其他替代的纤维化标志物表现更好(P<；0.001)。除了纤维化，其他与肝脏僵硬独立相关的因素是所有患者和慢性肝炎患者的ALT(P<；0.001)，以及肝硬化症患者持续12个月的ALT正常(生化缓解，P<；0.001)。在自发或抗病毒治疗后生化缓解的患者(48/228，21%)中，肝硬度低于相同纤维化阶段的患者，但升高了ALT(P<；0.001)。在10例肝炎加重患者中，肝脏硬度动态变化与ALT平行，在ALT发作期间增加1.3-3倍。21例肝脏硬度无变化，生化活性稳定(P=0.001)。总之，瞬时弹性成像是一项新的肝脏参数，可作为慢性病毒性肝炎患者纤维化的可靠替代指标，前提是考虑到其与主要生化活动变化的关系。
Liver stiffness was measured by transient elastography (FibroScan (R)) in 228 consecutive patients with chronic viral hepatitis, with (115) or without cirrhosis (113), to study its correlations with serum transaminases [alanine aminotransferase (ALT)], fibrosis stage and surrogate noninvasive markers of fibrosis (APRI, FORNS, FibroTest and hyaluronic acid). The dynamic profiles of serum transaminases and liver stiffness were compared by multiple testing in 31 patients during a 6-month follow-up. We identified 8.3 and 14 kPa as the fibrosis >= F2 and cirrhosis cut-offs, respectively: their sensitivities were 85.2%/78.3%; specificities 90.7%/98.2%; positive predictive values 93.9%/97.8%; negative predictive values 78.8%/81.6%; diagnostic accuracies 87.3%/88.2%. FibroScan((R)) performed better than the other surrogate markers of fibrosis (P < 0.001). Other than fibrosis, other factors independently associated with liver stiffness were ALT for all patients and chronic hepatitis patients (P < 0.001), and 12-month persistently normal ALT (biochemical remission, P < 0.001) in cirrhotics. In patients with biochemical remission either spontaneous or after antiviral therapy (48 of 228, 21%), liver stiffness was lower than in patients with identical fibrosis stage, but elevated ALT (P < 0.001). The liver stiffness dynamic profiles paralleled those of ALT, increasing 1.3- to 3-fold during ALT flares in 10 patients with hepatitis exacerbations. Liver stiffness remained unchanged in 21 with stable biochemical activity (P = 0.001). In conclusion, transient elastography is a new liver parameter that behaves as a reliable surrogate marker of fibrosis in chronic viral hepatitis patients, provided that its relationship with major changes of biochemical activity is taken into account.