Performance and utility of transient elastography and noninvasive markers of liver fibrosis in primary biliary cirrhosis
Performance and utility of transient elastography and noninvasive markers of liver fibrosis in primary biliary cirrhosis
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DOI：
10.1016/j.dld.2011.06.011
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发表时间：
2011-11-01
影响因子：
4.5
通讯作者：
Chemello, Liliana
中科院分区：
文献类型：
--
作者：
Floreani, Annarosa;Cazzagon, Nora;Chemello, Liliana
背景：瞬时弹性成像在原发性胆汁性肝硬化中的表现尚未完全确定。目的：评估：(1)通过与替代指标（AST血小板比值指数（APRI）、FIB-4、Fibroindex、Forns、天冬氨酸转氨酶/丙氨酸转氨酶比值）的比较，瞬时弹性成像在原发性胆汁性肝硬化中识别显著纤维化的性能；(2)肝脏僵硬度与Mayo评分预后指数的相关性。方法：120例原发性胆汁性肝硬化患者连续入选。在肝活检时，将各标志物和肝硬度的表现与组织学分期和METAVIR进行比较。结果：组织学分期>= II、>= III、=IV的受试者工作特征（ROC）下肝脏僵硬面积分别为0.87、0.88、0.99，METAVIR分期>= 2、>= 3、=4的受试者工作特征面积分别为0.89、0.92、0.99。与无创标记物相比，单纯瞬时弹性成像能够更好地识别任何级别的纤维化或肝硬化。将每个替代标记物与瞬态弹性成像相结合并没有改善ROC下的面积。瞬时弹性成像与Mayo评分呈正相关（P < 0.001）。Logistic回归分析显示，瞬时弹性成像与晚期纤维化相关（P < 0.001）。结论：瞬时弹性成像被证明是评估原发性胆汁性肝硬化肝纤维化的一种简单、可靠和有用的方法，而非侵入性替代标志物在预测显著纤维化方面被证明是不满意的。(C) 2011 Editrice gastroenteritaliana S.r.l, Elsevier Ltd.出版版权所有。
Background: The performance of transient elastography in primary biliary cirrhosis has yet to be fully established.Aim: To assess: (I) the performance of transient elastography in identifying significant fibrosis in primary biliary cirrhosis by comparison with surrogate markers (AST platelet ratio index (APRI), FIB-4, Fibroindex, Forns, aspartate aminotransferase/alanine aminotransferase ratio): (2) the correlation between liver stiffness and Mayo score prognostic index.Methods: One hundred and twenty patients with primary biliary cirrhosis were consecutively enrolled. The performance of each marker and of liver stiffness was compared with histological staging and METAVIR at time of liver biopsy.Results: The area under receiver operating characteristic (ROC) of liver stiffness were 0.87, 0.88, 0.99 for histological stage >= II, >= III and =IV and 0.89, 0.92, 0.99 for METAVIR >= 2, >= 3 and =4. Transient elastography alone proved better able in identifying any grade of fibrosis or cirrhosis than noninvasive markers. Combining each surrogate marker with transient elastography did not improve the area under ROC. Transient elastography correlated positively with the Mayo score (P < 0.001). Logistic regression analysis showed that transient elastography was associated with an advanced fibrosis (P < 0.001).Conclusions: Transient elastography proved a simple, reliable and useful method for assessing liver fibrosis in primary biliary cirrhosis, whereas noninvasive surrogate markers proved unsatisfactory in predicting significant fibrosis. (C) 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.