Biomed Res Int. 2019 Jan 23;2019:3951574. doi: 10.1155/2019/3951574. eCollection 2019.
Transient Elastography and Ultrasonography: Optimal Evaluation of Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease.
Zhang GL1,2, Zhao QY1,2, Lin CS1,2, Hu ZX1,2, Zhang T3, Gao ZL1,2,4.
Author information
1
Department of Infectious Diseases, The Third Affiliated Hospital of Sun-Yat-sen University, Guangzhou, China.
2
Guangdong Provincial Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun-Yat-sen University, Guangzhou, China.
3
Department of Ultrasound, The Third Affiliated Hospital of Sun-Yat-sen University, Guangzhou, China.
4
Key Laboratory of Tropical Disease Control, Sun-Yat-sen University, Ministry of Education, Guangzhou, China.
Abstract
Background and Aims:
Concordance between transient elastography (TE) and ultrasonography (US) in assessing liver fibrosis in patients with chronic hepatitis B (CHB) and concurrent nonalcoholic fatty liver disease (NAFLD) has been rarely studied. This study aimed to evaluate the individual and combined performances of TE and US in assessing liver fibrosis and cirrhosis.
Patients and Methods:
Consecutive CHB patients with NAFLD were prospectively enrolled. TE and US examinations were performed, with liver biopsy as a reference standard. Receiver operating characteristic (ROC) curves were obtained to evaluate the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared using DeLong's test.
Results:
TE and US scores correlated significantly with the histological fibrosis staging scores. TE was significantly superior to US in the diagnosis of significant fibrosis (AUC, 0.84 vs 0.73; P=0.02), advanced fibrosis (AUC, 0.95 vs 0.76; P<0.001), and cirrhosis (AUC, 0.96 vs 0.71; P<0.001). Combining TE with US did not increase the accuracy of detecting significant fibrosis, advanced cirrhosis, or cirrhosis (P=0.62, P=0.69, and P=0.38, respectively) compared to TE alone. However, TE combined with US significantly increased the positive predictive value for significant fibrosis when compared to TE alone. The optimal cut-off values of TE for predicting advanced fibrosis and cirrhosis were 8.7 kPa and 10.9 kPa, with negative predictive values of 92.4% and 98.7%, respectively.
Conclusions:
TE is useful for predicting hepatic fibrosis and excluding cirrhosis in CHB patients with NAFLD. A combination of TE and US does not improve the accuracy in assessing liver fibrosis or cirrhosis.
TE和US评分与组织学纤维化分期评分显着相关。 TE在显着纤维化诊断中显着优于US（AUC，0.84 vs 0.73; P = 0.02），晚期纤维化（AUC，0.95 vs 0.76; P <0.001）和肝硬化（AUC，0.96 vs 0.71; P <0.001 ）。与单独的TE相比，将TE与US组合并未提高检测显着纤维化，晚期肝硬化或肝硬化（分别为P = 0.62，P = 0.69和P = 0.38）的准确性。然而，与单独的TE相比，TE与US联合显着增加了显着纤维化的阳性预测值。 TE预测晚期纤维化和肝硬化的最佳临界值分别为8.7 kPa和10.9 kPa，阴性预测值分别为92.4％和98.7％。
结论：