Quantitative assessment of liver fibrosis reveals a nonlinear association with fibrosis stage in nonalcoholic fatty liver disease.
Quantitative assessment of liver fibrosis reveals a nonlinear association with fibrosis stage in nonalcoholic fatty liver disease.
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肝纤维化的定量评估揭示了非酒精性脂肪肝病中纤维化阶段的非线性关联。
DOI：
10.1002/hep4.1121
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发表时间：
2018-01
影响因子：
5.1
通讯作者：
Sakamoto M
中科院分区：
文献类型：
--
作者：
Masugi Y;Abe T;Tsujikawa H;Effendi K;Hashiguchi A;Abe M;Imai Y;Hino K;Hige S;Kawanaka M;Yamada G;Kage M;Korenaga M;Hiasa Y;Mizokami M;Sakamoto M
肝纤维化的准确分期对于指导非酒精性脂肪性肝病（NAFLD）患者的治疗决策至关重要。数字图像分析已成为定量评估慢性肝病纤维化的一种有前途的工具。为了更好地了解NAFLD的进展，我们试图确定组织学纤维化分期与肝活检标本中定量纤维量的关系。我们使用自动计算方法测量了来自四家医院的289例NAFLD患者的Elastica货车Gieson染色活检组织中胶原和弹性蛋白纤维的面积比，并检查了它们与Brunt纤维化分期的相关性。作为二次分析，我们进行了多变量逻辑回归分析，以评估胶原蛋白和弹性蛋白的组合面积比与非侵入性纤维化标志物的相关性。合并的纤维面积比与Brunt分期密切相关（斯皮尔曼相关系数，0.78; P < 0.0001），但这种关系是非线性的（P = 0.007），4期（中位面积比，12.3%）和0 - 3期（分别为2.1%、2.8%、4.3%和4.8%）之间存在显著差异。弹性蛋白积聚常见于厚桥接纤维化和增厚的静脉壁区域，但不常见于窦周纤维化区域。在多变量分析中，组合纤维面积比的最高三分位数与纤维化-4指数和血清IV型胶原7s结构域（7s胶原）水平相关，而纤维量的上两个三分位数与体重指数、天冬氨酸转氨酶和7s胶原显著相关。总结：定量纤维化评估揭示了纤维化分期和纤维量之间的非线性关系，4期和3期之间存在显著差异，0 - 3期之间的差异要小得多，表明NAFLD相关肝硬化的疾病严重程度存在异质性。（Hepatology Communications 2018;2：58-68）
Accurate staging of liver fibrosis is crucial to guide therapeutic decisions for patients with nonalcoholic fatty liver disease (NAFLD). Digital image analysis has emerged as a promising tool for quantitative assessment of fibrosis in chronic liver diseases. We sought to determine the relationship of histologic fibrosis stage with fiber amounts quantified in liver biopsy specimens for the better understanding of NAFLD progression. We measured area ratios of collagen and elastin fibers in Elastica van Gieson‐stained biopsy tissues from 289 patients with NAFLD from four hospitals using an automated computational method and examined their correlations with Brunt's fibrosis stage. As a secondary analysis, we performed multivariable logistic regression analysis to assess the associations of the combined area ratios of collagen and elastin with noninvasive fibrosis markers. The combined fiber area ratios correlated strongly with Brunt's stage (Spearman correlation coefficient, 0.78; P < 0.0001), but this relationship was nonlinear (P = 0.007) with striking differences between stage 4 (median area ratios, 12.3%) and stages 0‐3 (2.1%, 2.8%, 4.3%, and 4.8%, respectively). Elastin accumulation was common in areas of thick bridging fibrosis and thickened venous walls but not in areas of perisinusoidal fibrosis. The highest tertile of the combined fiber area ratios was associated with the fibrosis‐4 index and serum type IV collagen 7s domain (7s collagen) levels, whereas the upper two tertiles of the fiber amounts significantly associated with body mass index, aspartate aminotransferase, and 7s collagen in the multivariable analysis. Conclusion: Quantitative fibrosis assessment reveals a nonlinear relationship between fibrosis stage and fiber amount, with a marked difference between stage 4 and stage 3 and much smaller differences among stages 0‐3, suggesting a heterogeneity in disease severity within NAFLD‐related cirrhosis. (Hepatology Communications 2018;2:58–68)
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影响因子：
5.1
作者：
Kleiner DE;Makhlouf HR
通讯作者：
Makhlouf HR
影响因子：
5.1
作者：
Brunt EM
通讯作者：
Brunt EM
影响因子：
2.2
作者：
Almpanis Z;Demonakou M;Tiniakos D
通讯作者：
Tiniakos D
影响因子：
13.5
作者：
Kim, Donghee;Kim, W. Ray;Kim, Hwa Jung;Therneau, Terry M.
通讯作者：
Therneau, Terry M.
肝脏中的弹性。
影响因子：
4
作者：
Kanta J
通讯作者：
Kanta J