CAJ | 학술논문

目的探讨瞬时弹性扫描(TE)诊断慢性乙型肝炎(CHB)肝纤维化状态的临床价值.方法 969例CHB患者纳入研究,均接受TE检查,其中258例还接受肝活检,117例接受胃镜检查食管静脉曲张情况.结果 35例患者因TE检查成功率低于60%或肝脏弹性值(LSM)四分位偏差值/LSM比值高于0.3而被剔除.影响LSM的因素包括胆红素、AST、肝纤维化分期、炎症分级、超声波评分及血白蛋白水平.TE预测肝硬化Child-PughC级、B/C级、肝纤维化分期S4、≥S3、≥S2的接受者操作特征(ROC)曲线下面积分别为0.907、0.920、0.871、0.852及0.807.LSM＜32.2 kPa时排除Child-Pugh C级的可能性为99.4%,LSM≥35.3 kPa时诊断Child-Pugh B/C级的可能性为82.0%.对于代偿性CHB,LSM临界值23.3、15.2及10.8 kPa诊断肝硬化、肝纤维化分期≥S3及≥S2的阳性似然比均接近10.0;LSM临界值8.8、6.6 kPa排除肝硬化、肝纤维化分期≥S3的阴性似然比接近0.1.LSM与食管静脉曲张分期的等级相关系数仅为0.180,TE预测食管静脉曲张的ROC曲线下面积似无临床意义.结论 TE可较准确预测CHB患者肝纤维化严重性及Child-Pugh等级,LSM≥10.8 kPa的患者应考虑抗病毒治疗.
목적 탐토순시탄성소묘(TE)진단만성을형간염(CHB)간섬유화상태적림상개치.방법 969례CHB환자납입연구,균접수TE검사,기중258례환접수간활검,117례접수위경검사식관정맥곡장정황.결과 35례환자인TE검사성공솔저우60%혹간장탄성치(LSM)사분위편차치/LSM비치고우0.3이피척제.영향LSM적인소포괄담홍소、AST、간섬유화분기、염증분급、초성파평분급혈백단백수평.TE예측간경화Child-PughC급、B/C급、간섬유화분기S4、≥S3、≥S2적접수자조작특정(ROC)곡선하면적분별위0.907、0.920、0.871、0.852급0.807.LSM＜32.2 kPa시배제Child-Pugh C급적가능성위99.4%,LSM≥35.3 kPa시진단Child-Pugh B/C급적가능성위82.0%.대우대상성CHB,LSM림계치23.3、15.2급10.8 kPa진단간경화、간섬유화분기≥S3급≥S2적양성사연비균접근10.0;LSM림계치8.8、6.6 kPa배제간경화、간섬유화분기≥S3적음성사연비접근0.1.LSM여식관정맥곡장분기적등급상관계수부위0.180,TE예측식관정맥곡장적ROC곡선하면적사무림상의의.결론 TE가교준학예측CHB환자간섬유화엄중성급Child-Pugh등급,LSM≥10.8 kPa적환자응고필항병독치료.
Objective To evaluate the value of transient elastography (TE) for predicting severity of liver fibrosis in patients with chronic hepatitis B (CHB).Methods A total of 969 patients with CHB was enrolled and recruited for analysis,which had been received TE scan,including 258 patients of liver biopsy,and 117 patients of gastric endoscopy.Results A total of 35 patients was excluded from analysis due to TE failure or unreliable TE.Liver stiffness measurement (LSM) was independently influenced by bilirubin,AST,liver fibrosis and inflammation,ultrasonic score and albumin.TE predicted Child-Pugh C,B/C,liver fibrosis S4,≥S3 and ≥ S2 with respective area under receiver operating characteristics curves (AUROC)0.907 (95% CI 0.886-0.928 ),0.920 ( 95% CI 0.899-0.940 ),0.871 ( 95% CI 0.819-0.923 ),0.852(95%CI0.805-0.899) and 0.807(95% CI0.749-0.865),respectively.While LSM ＜32.2 kPa excluded Child-Pugh C with 99.4% probability,LSM ≥35.3 kPa determined Child-Pugh B/C with positive predictive value (PPV) 0.820.For compensated CHB,cut-offs of LSM 23.3,15.2 and 10.8 kPa diagnosed cirrhosis,liver fibrosis ≥S3 and ≥S2 with positive likelihood ratio nearly 10.0 and PPV 0.692,0.882 and 0.980,respectively; and cut-offs 8.8 kPa,6.6 kPa excluded cirrhosis,liver fibrosis ≥ S3 with negative likelihood ration nearly 0.1 and negative predictive value 0.977 and 0.903,respectively.Correlation coefficient between LSM and grades of esophageal varices was only 0.180,and AUROC for TE predicting EV was of no clinical value.ConclusionTE relatively make accurate prediction in the severity of liver fibrosis and classification of Child-Pugh.Patients with LSM ≥ 10.8 kPa should be considered for receiving antivirus treatment.