Comparison of liver biopsy and transient elastography based on clinical relevance
Comparison of liver biopsy and transient elastography based on clinical relevance
复制标题
DOI：
10.1155/2008/306726
复制
发表时间：
2008-09-01
影响因子：
2.7
通讯作者：
Omata, Masao
中科院分区：
文献类型：
--
作者：
Masuzaki, Ryota;Tateishi, Ryosuke;Omata, Masao
背景：通过瞬时弹性成像测量肝脏硬度(LSM)最近已被证实用于评估慢性肝病的肝纤维化。方法：选择2004年12月至2007年4月接受肝活检的慢性丙型肝炎患者386例。首先，根据受试者的工作特性曲线，选择LSM的最佳临界值来判定肝硬变。然后，选择肝组织学与LSM评价不一致的病例。对血清总胆红素浓度、凝血酶原活动度、白蛋白浓度、血小板计数、天冬氨酸氨基转移酶/血小板比值指数等实验室检查结果以及有无食道静脉曲张进行分析。结果：选择15.9kPa值作为判断肝硬变(纤维化分期[F]4)的最佳临界值，使灵敏度(78.9%)和特异度(81.0%)之和最大化。不一致者78例：LSM≥15.9kPa者51例，纤维化分期F1~F3者(高LSM组)；LSM<15.9kPa者27例，纤维化分期F4者(低LSM组)。高LSM组(n=51)11例出现食道静脉曲张，低LSM组(n=27)无一例出现食道静脉曲张(P=0.0012)。天冬氨酸氨基转移酶/血小板比值指数在低氧血症组显著高于低氧血症组(1.49vs0.89，P=0.019)。其他参数没有显著差异。然而，高LSM组的血小板计数、凝血酶原活性和白蛋白浓度往往较低。结论：即使肝活检未发现肝硬变，高LSM组的患者仍需适当注意肝硬变。
Background: Liver stiffness measurement (LSM) by transient elastography has recently been validated for the evaluation of liver fibrosis in chronic liver diseases. The present study focused on cases in which liver biopsy and LSM were discordant.METHODS: Three hundred eighty-six patients with chronic hepatitis C who underwent a liver biopsy between December 2004 and April 2007 were studied. First, the optimal cut-off value of LSM was selected for the determination of cirrhosis based on the receiver operating characteristic curve. Then, the cases in which liver histology and evaluation by LSM were discordant were selected. Laboratory test results such as serum total bilirubin concentration, prothrombin activity, albumin concentration, platelet count and the aspartate aminotransferase to platelet ratio index, together with the presence of esophageal varices, were analyzed.RESULTS: The optimal cut-off value was chosen to be 15.9 kPa for cirrhosis (fibrosis stage [F]4) determination to maximize the sum of sensitivity (78.9%) and specificity (81.0%). There were 78 discordant cases: 51 patients showed an LSM of 15.9 kPa or higher and a fibrosis stage of F1 to F3 (high LSM group), and 27 patients had an LSM lower than 15.9 kPa and a fibrosis stage of F4 (low LSM group). Esophageal varices were seen in 11 patients in the high LSM group (n=51) and in no patients in the low LSM group (n=27) (P=0.0012). The aspartate aminotransferase to platelet ratio index was significantly higher in the high LSM group (1.49 versus 0.89, P=0.019). Other parameters did not differ significantly. However, platelet count, prothrombin activity and albumin concentration tended to be lower in the high LSM group.CONCLUSIONS: Patients with a high LSM need proper attention for cirrhosis, even if liver biopsy does not reveal cirrhosis.