Baseline Values and Changes in Liver Stiffness Measured by Transient Elastography Are Associated With Severity of Fibrosis and Outcomes of Patients With Primary Sclerosing Cholangitis
Baseline Values and Changes in Liver Stiffness Measured by Transient Elastography Are Associated With Severity of Fibrosis and Outcomes of Patients With Primary Sclerosing Cholangitis
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DOI：
10.1053/j.gastro.2013.12.030
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发表时间：
2014-04-01
期刊：
影响因子：
29.4
通讯作者：
Chazouilleres, Olivier
中科院分区：
文献类型：
--
作者：
Corpechot, Christophe;Gaouar, Farid;Chazouilleres, Olivier
背景与目的：原发性硬化性胆管炎（PSC）是一种慢性胆汁淤积性疾病，可导致广泛的肝纤维化和肝硬化，并与不良预后相关。然而，PSC 患者的肝纤维化尚无经过验证的非侵入性标志物。我们使用振动控制瞬时弹性成像 (VCTE) 评估了肝脏硬度测量 (LSM) 的诊断性能、可重复性、纵向变化和预后价值。方法：在一项前瞻性研究中，我们分析了 2005 年 1 月至 2010 年 12 月期间连续 73 名 PSC 患者的经皮肝活检标本。患者在术后 6 个月内接受了 VCTE 收集活检标本。活检标本由不知道 VCTE 结果的纤维化阶段病理学家进行分析，并使用 Kruskal-Wallis 和 Spearman 相关性检验将 LSM 与纤维化阶段和其他变量相关联。 LSM 的截止值是根据接受者操作特征分析中识别纤维化阶段的准确性来选择的。使用线性混合模型评估 LSM 进展率，并使用 Cox 回归分析评估 168 名接受熊去氧胆酸治疗的 PSC 患者并进行随访（平均随访期为 4 年）。结果：LSM 与纤维化阶段独立相关。纤维化阶段 >= F1、>= F2、>= F3 和 F4 的截止值分别为 7.4 kPa、8.6 kPa、9.6 kPa 和 14.4 kPa。严重纤维化和肝硬化的调整后诊断准确度值分别为 0.83 和 0.88。 LSM 的诊断性能与透明质酸测量相当，但在区分显着或严重纤维化患者与无纤维化患者方面优于天冬氨酸转氨酶/血小板比值指数、FIB-4 评分和 Mayo 风险评分。 LSM 在同一测量站点的操作员之间以及两个相邻站点之间的同一操作员之间具有高水平的再现性。随着时间的推移，LSM 显着呈指数增长。基线测量值和 LSM 进展率与患者的结局密切且独立相关。结论：VCTE 能够区分严重和非严重肝纤维化，对 PSC 患者具有很高的置信度。 LSM 的基线测量和纵向变化是 PSC 的预后因素。
BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease that leads to extensive liver fibrosis and cirrhosis, which are associated with poor outcome. However, there are no validated noninvasive markers of liver fibrosis in patients with PSC. We assessed the diagnostic performance, reproducibility, longitudinal changes, and prognostic value of liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE).METHODS: In a prospective study, we analyzed percutaneous liver biopsy specimens from 73 consecutive patients with PSC from January 2005 to December 2010. Patients underwent VCTE no more than 6 months after the biopsy specimens were collected. The biopsy specimens were analyzed by a pathologist blinded to the results of VCTE for the stage of fibrosis, and LSM was associated with the stage of fibrosis and other variables using the Kruskal-Wallis and Spearman correlation tests. The cutoff values of LSM were selected based on the accuracy with which they identified the stage of fibrosis on receiver-operating characteristic analysis. The rates of LSM progression were assessed using a linear mixed model, and the association between LSM values and clinical outcomes were evaluated using Cox regression analysis in 168 patients with PSC treated with ursodeoxycholic acid and followed up from November 2004 to July 2013 (mean follow-up period, 4 years).RESULTS: LSM was independently linked to the stage of fibrosis. Cutoff values for fibrosis stages >= F1, >= F2, >= F3, and F4 were 7.4 kPa, 8.6 kPa, 9.6 kPa, and 14.4 kPa, respectively. The adjusted diagnostic accuracy values for severe fibrosis and cirrhosis were 0.83 and 0.88, respectively. The diagnostic performance of LSM was comparable to that of hyaluronic acid measurement but superior to the aspartate aminotransferase/ platelet ratio index, FIB-4 score, and Mayo risk score in differentiating patients with significant or severe fibrosis from those without. LSM had a high level of reproducibility between operators for the same measurement site and for the same operator between 2 adjacent sites. LSM increased significantly and exponentially over time. Baseline measurements and rate of LSM progression were strongly and independently linked with patients' outcomes.CONCLUSIONS: VCTE is able to differentiate severe from nonsevere liver fibrosis with high levels of confidence in patients with PSC. Baseline measurements of LSM and longitudinal changes are prognostic factors for PSC.