Assessment of liver fibrosis by transient elastography in persons with hepatitis C virus infection or HIV-hepatitis C virus coinfection.
Assessment of liver fibrosis by transient elastography in persons with hepatitis C virus infection or HIV-hepatitis C virus coinfection.
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DOI：
10.1086/597350
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发表时间：
2009-04-01
期刊：
影响因子：
--
通讯作者：
Thomas DL
中科院分区：
文献类型：
--
作者：
Kirk GD;Astemborski J;Mehta SH;Spoler C;Fisher C;Allen D;Higgins Y;Moore RD;Afdhal N;Torbenson M;Sulkowski M;Thomas DL
瞬时弹性成像是一种新颖的、无创的肝纤维化分期方法。我们在以黑人为主的城市研究人群中，对丙型肝炎病毒 (HCV) 感染和人类免疫缺陷病毒 (HIV) - HCV 合并感染的参与者进行了弹性成像与组织学方法的比较。从艾滋病相关静脉注射经验和约翰霍普金斯大学艾滋病毒临床队列研究中招募的参与者接受了弹性成像以确定肝脏硬度测量值。肝活检标本根据 Metavir 评分进行 F0-F4 分期。与组织学方法相比，诊断准确性和肝脏硬度截止值的确定是通过接受者操作特征分析来确定的。逻辑回归方法识别与不一致的分类状态相关的参数。在 192 名参与者中，139 名 (72%) 人同时感染 HIV 和 HCV，121 人 (63%) 患有轻微纤维化，48 人 (25%) 患有肝硬化。总体而言，检测显着纤维化（95% 置信区间，0.82–0.92）和肝硬化（95% 置信区间，0.81–0.93）的曲线下面积接收器操作特征为 0.87。使用≥9.3 kPa的纤维化截止值和≥12.3 kPa的肝硬化截止值，79%–83%的参与者通过肝脏硬度测量被正确分类（与组织学方法相比）；未感染艾滋病毒的参与者的准确性似乎高于感染艾滋病毒的参与者。大多数不一致发生在肝脏硬度测量表明存在肝脏疾病而组织学检查没有表明存在肝脏疾病时（16% 的参与者）；与通过活检标本和弹性成像检查预测纤维化程度较低的患者相比，具有这些不一致结果的患者更有可能具有增加显着纤维化几率的属性，例如血清纤维化标志物升高或 HIV 相关免疫抑制。对于大多数 HCV 感染者来说，通过弹性成像预测的纤维化阶段与通过活检标本检查预测的纤维化阶段相似。基于弹性成像的肝脏硬度测量有望扩大肝脏疾病筛查和监测，特别是注射吸毒者。
Transient elastography is a novel, noninvasive method for staging liver fibrosis. We compared elastography with histologic methods among hepatitis C virus (HCV)–infected and human immunodeficiency virus (HIV)–HCV-coinfected participants in an urban, predominantly black study population. Participants recruited from the AIDS Linked to the Intravenous Experience and the Johns Hopkins HIV Clinical Cohort studies underwent elastography to determine liver stiffness measurements. Liver biopsy specimens were staged F0–F4 in accordance with the Metavir score. Diagnostic accuracy and determination of liver stiffness cutoff values, compared with histologic methods, were determined by receiver operating characteristic analysis. Logistic regression methods identified parameters associated with discordant classification status. Of 192 participants, 139 (72%) were coinfected with HIV and HCV, 121 (63%) had insignificant fibrosis, and 48 (25%) had cirrhosis. Overall, the area-under-the-curve receiver operating characteristic was 0.87 for detection of both significant fibrosis (95% confidence interval, 0.82–0.92) and cirrhosis (95% confidence interval, 0.81–0.93). With use of cutoff values of ≥9.3 kPa for fibrosis and ≥12.3 kPa for cirrhosis, 79%–83% of participants were correctly classified by liver stiffness measurement (compared with histologic methods); accuracy appeared to be higher among HIV-uninfected participants than among HIV-infected participants. Most discordance occurred when liver stiffness measurements indicated liver disease and histologic examination did not (in 16% of participants); the patients with these discordant results were more likely to have attributes that increased the odds of significant fibrosis, such as elevated serum fibrosis markers or HIV-related immunosuppression, compared with persons in whom low fibrosis was predicted by both examination of a biopsy specimen and elastography. For most HCV-infected persons, fibrosis stage predicted by elastography is similar to that predicted by examination of a biopsy specimen. Elastography-based measurement of liver stiffness holds promise to expand liver disease screening and monitoring, particularly among injection drug users.
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影响因子：
13.5
作者：
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通讯作者：
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9.8
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