Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C
Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C
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DOI：
10.1002/hep.20506
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发表时间：
2005-01-01
期刊：
影响因子：
13.5
通讯作者：
Beaugrand, M
中科院分区：
文献类型：
--
作者：
Ziol, M;Handra-Luca, A;Beaugrand, M
肝纤维化是慢性丙型肝炎进展的主要预测因素，通过肝活检（LB）对其进行评估可以帮助确定治疗。然而，活检是一种有创手术，有几个局限性。一种新的，非侵入性的医疗设备的基础上瞬态弹性成像已被设计来测量肝脏硬度。本研究的目的是探讨肝硬度测量（LSM）在慢性丙型肝炎患者肝纤维化评估中的应用。我们在一项多中心研究中前瞻性地招募了327例慢性丙型肝炎患者。患者接受了LB和LSM。由2名病理学家对活检标本进行METAVIR肝纤维化分期评估。通过瞬时弹性成像进行LSM。通过受试者工作特征（ROC）曲线分析确定LSM的效率和纤维化分期评估的最佳截止值，并通过刀切法进行交叉验证。LSM与纤维化分期密切相关（Kendall相关系数：0.55; P = 2，F >= 3时为0.91（0.87-0.96），F = 4时为0.97（0.93-1）;对于较大活检组织，这些值分别为0.81、0.95和0.99。8.7和14.5 kPa的最佳刚度截止值分别显示F >= 2和F = 4。总之，用瞬时弹性成像无创评估肝硬度似乎是检测慢性丙型肝炎患者显著纤维化或肝硬化的可靠工具。
Liver fibrosis is the main predictor of the progression of chronic hepatitis C, and its assessment by liver biopsy (LB) can help determine therapy. However, biopsy is an invasive procedure with several limitations. A new, noninvasive medical device based on transient elastography has been designed to measure liver stiffness. The aim of this study was to investigate the use of liver stiffness measurement (LSM) in the evaluation of liver fibrosis in patients with chronic hepatitis C. We prospectively enrolled 327 patients with chronic hepatitis C in a multicenter study. Patients underwent LB and LSM. METAVIR liver fibrosis stages were assessed on biopsy specimens by 2 pathologists. LSM was performed by transient elastography. Efficiency of LSM and optimal cutoff values for fibrosis stage assessment were determined by a receiver-operating characteristics (ROC) curve analysis and cross-validated by the jack-knife method. LSM was well correlated with fibrosis stage (Kendall correlation coefficient: 0.55; P = 2, 0.91 (0.87-0.96) for F >= 3, and 0.97 (0.93-1) for F = 4; for larger biopsies, these values were, respectively, 0.81, 0.95, and 0.99. Optimal stiffness cutoff values of 8.7 and 14.5 kPa showed F >= 2 and F = 4, respectively. In conclusion, noninvasive assessment of liver stiffness with transient elastography appears as a reliable tool to detect significant fibrosis or cirrhosis in patients with chronic hepatitis C.