Direct comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C
Direct comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C
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DOI：
10.1111/j.1478-3231.2011.02660.x
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发表时间：
2012-04-01
影响因子：
6.7
通讯作者：
Marcellin, Patrick
中科院分区：
文献类型：
--
作者：
Cardoso, Ana-Carolina;Carvalho-Filho, Roberto J.;Marcellin, Patrick
背景/目的：瞬时弹性成像（TE）在B型肝炎病毒（HBV）感染中的准确性尚未得到很好的确定。我们的目的是比较TE评估慢性HBV或丙型肝炎病毒（HCV）感染患者肝纤维化的性能。进行了次要分析，以评估丙氨酸氨基转移酶（ALT）水平是否会影响TE的准确性。研究方法：这项横断面研究在一个中心进行，纳入了2006年至2008年期间连续入院接受肝活检和同一天TE测量的代偿性慢性HBV或HCV感染的初治患者。结果：共评价了202例HBV患者和363例HCV受试者。HBV组TE的总体诊断准确性与HCV组相当[接受者操作特征下面积（AUROC）0.867 +/-0.026 vs. 0.868 +/-0.019预测F +/-2，P = 0.975; F +/-3的0.902 +/-0.029 vs. 0.894 +/-0.020，P = 0.820; F4分别为0.935 +/-0.024 vs. 0.947 +/-0.027，P = 0.740]。TE在HBV和HCV组中表现出相当的准确性、敏感性、特异性、预测值和似然比。AUROC分析显示ALT水平对HBV个体的TE性能没有影响。ALT特异性临界值在预测ALT升高的HBV患者纤维化方面没有表现出显著更高的诊断性能。结论：在HBV患者中，TE测量准确预测是否存在显著纤维化、晚期纤维化或肝硬化，并显示与HCV患者相似的表现。使用根据ALT水平调整的TE临界值并不能改善HBV患者肝纤维化的评估性能。
Background/ Aims: Accuracy of transient elastography (TE) in hepatitis B virus (HBV) infection has not been well established. We aimed to compare the performances of TE for the assessment of liver fibrosis in patients with chronic HBV or hepatitis C virus (HCV) infection. A secondary analysis was performed to assess whether or not alanine aminotransferase (ALT) levels would impact on the accuracy of TE. Methods: This cross-sectional study, carried out in a single centre, included treatment-naive patients with compensated chronic HBV or HCV infection, consecutively admitted between 2006 and 2008 for a liver biopsy and TE measurement on the same day. Results: A total of 202 HBV patients and 363 HCV subjects were evaluated. Overall diagnostic accuracy of TE in the HBV group was comparable to that observed in HCV patients [area under the receiver-operating characteristics (AUROCs) 0.867 +/-0.026 vs. 0.868 +/-0.019 for predicting F +/-2, P = 0.975; 0.902 +/-0.029 vs. 0.894 +/-0.020 for F +/-3, P = 0.820; and 0.935 +/-0.024 vs. 0.947 +/-0.027 for F4, P = 0.740 respectively]. TE exhibited comparable accuracies, sensitivities, specificities, predictive values and likelihood ratios in HBV and HCV groups. AUROC analysis showed no influence of ALT levels on the performance of TE in HBV individuals. ALT-specific cut-off values did not exhibit significantly higher diagnostic performances for predicting fibrosis in HBV patients with elevated ALT. Conclusions: In HBV patients, TE measurement accurately predicts the absence or presence of significant fibrosis, advanced fibrosis or cirrhosis and shows similar performances as compared to HCV patients. The use of TE cut-off values adjusted to ALT level did not improve performances for estimating liver fibrosis in HBV patients.