Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases
Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases
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DOI：
10.1002/hep.21420
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发表时间：
2006-12-01
期刊：
影响因子：
13.5
通讯作者：
Beaugrand, Michel
中科院分区：
文献类型：
--
作者：
Ganne-Carrie, Nathahe;Ziol, Marianne;Beaugrand, Michel
肝硬化的正确诊断对于慢性肝病患者的管理至关重要。我们在一项前瞻性多中心研究中评估了Fibroscan测量肝脏硬度诊断1,257例各种原因慢性肝病患者肝硬化的准确性，并澄清了肝组织学和Fibroscan之间差异的原因。132例患者的活检标本不合适，118例患者的肝硬度测量结果不可靠。由于232例患者与先前的研究重叠，因此在775例新患者中进行分析，然后在整个人群中进行分析（1，007; 165例肝硬化）。通过受试者工作曲线（ROC）分析评估诊断准确性。如果存在差异，则重新分析肝脏样本。在775或1,007例患者中，诊断肝硬化的ROC下面积（AUROC）为0.95（95%CI，0.93-0.96）。在1,007例患者中，最佳诊断准确性的临界值为14.6 kPa（阳性和阴性预测值，74%和96%），不同病因组之间存在差异。80例误诊为：（1）45例肝硬度≥ 14.6kPa的非肝硬化患者中，27例（60%）为广泛纤维化，10例（22%）为明显窦周纤维化;（2）35例肝硬化患者中，肝硬度<14.6kPa者，大结节型10例（29%），无活动或轻度活动者25例（71%）。总之，Fibroscan是诊断慢性肝病患者肝硬化的可靠方法，在排除肝硬化方面优于使用14.6 kPa阈值预测肝硬化。假阴性主要归因于非活动性或大结节性肝硬化。
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 perisinusoidat 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.