脂肪肝的严重程度会影响肝脏硬度测量患者的非酒精性脂肪

StephenW

The severity of steatosis influences liver stiffness measurement in patients with nonalcoholic fatty liver disease

    Salvatore Petta1,*, Marcello Maida1, Fabio Salvatore Macaluso1, Vito Di Marco1, Calogero Cammà1, Daniela Cabibi2 andAntonio Craxì1

Article first published online: 20 MAY 2015

DOI: 10.1002/hep.27844

© 2015 by the American Association for the Study of Liver Diseases

Issue
Hepatology
Hepatology

Volume 62, Issue 4, pages 1101–1110, October 2015
Article has an altmetric score of 6

    1    Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
    2    Cattedra di Anatomia Patologica, University of Palermo, Palermo, Italy

*Address reprint requests to: Dr. Salvatore Petta, Sezione di Gastroenterologia, Di.Bi.M.I.S., Policlinico Universitario Paolo Giaccone, Piazza delle Cliniche, 2, 90127 Palermo, Italy. E-mail: [email protected]; [email protected]; tel: +39-091-6552274; fax +39-091-6552156.

    Potential conflict of interest: Nothing to report.

    Supported by grants from PRIN 2010–2011 (Prot. N. 2010C4JJWB).

   

In nonalcoholic fatty liver disease, the influence of severity of steatosis on liver stiffness measurement (LSM) is poorly studied and still debated. We assessed the impact of steatosis severity and its ultrasonographic (US) sign, severe bright liver echo pattern, on LSM values and on transient elastography accuracy for the diagnosis of liver fibrosis in a cohort of consecutive patients with nonalcoholic fatty liver disease. Patients (n = 253) were assessed by clinical, US, and histological (Kleiner score) features. Transient elastography was performed using the M probe. Among patients with low amounts of fibrosis (F0-F1 and F0-F2), median LSM values, expressed in kilopascals, were significantly higher in subjects with severe steatosis (≥66% at liver biopsy) compared to those without (F0-F1 6.9 versus 5.8, P = 0.04; F0-F2 7.4 versus 6.0, P = 0.001) as well as in patients with severe bright liver echo pattern on US compared to their counterparts (F0-F1 7.3 versus 5.6, P = 0.001; F0-F2 7.6 versus 6.0, P < 0.001). In subjects without significant fibrosis (F0-F1) and without severe fibrosis (F0-F2), a higher rate of false-positive LSM results was observed in patients with steatosis ≥66% compared to those without (F0-F1 23.6% versus 14.9%, F0-F2 33.3% versus 13.2%) and in patients with severe bright liver echo pattern on US (F0-F1 22.2% versus 15.4%, F0-F2 28.8% versus 15.6%) compared to their counterparts. Conclusions: In patients with nonalcoholic fatty liver disease, the presence of severe steatosis, detected by histology or by US, should always be taken into account in order to avoid overestimations of liver fibrosis assessed by transient elastography. (Hepatology 2015;62:1101-1110)

StephenW

脂肪肝的严重程度会影响肝脏硬度测量患者的非酒精性脂肪肝病

    萨尔瓦多Petta1，*，马塞罗Maida1，法比奥萨尔瓦多Macaluso1，威霆迪Marco1，卡洛杰罗Cammà1，丹妮拉Cabibi2 andAntonioCraxì1

文章首次在线发表：二〇一五年五月二十零日

DOI：10.1002 / hep.27844

©2015年肝病研究的美国协会

问题
肝病
肝病

第62卷，第4期，页1101-1110，2015年10月
文章的altmetric比分6

    1 Sezione迪Gastroenterologia，Di.Bi.MIS，巴勒莫大学，巴勒莫，意大利
    2 Cattedra解剖病理学，巴勒莫大学，巴勒莫，意大利

*地址转载请：萨尔瓦多Petta博士，Sezione迪Gastroenterologia，Di.Bi.MIS，位于Policlinico宇宙报保罗Giaccone，广场阿尔Cliniche，2，90127巴勒莫，意大利。电子信箱：[email protected]; [email protected];联系电话：+ 39-091-6552274;传真：+ 39-091-6552156。

    潜在的利益冲突：无报告。

    由PRIN 2010 - 2011年（数据保护N. 2010C4JJWB）资助。

   

在非酒精性脂肪肝，脂肪肝对肝脏硬度测量（LSM）的严重程度的影响研究甚少，仍然争论不休。我们评估脂肪变性的严重程度及其超声（美国）的标志，明亮的严重肝回声模式的影响，对LSM值和瞬时弹性成像精度为肝纤维化的连续治疗非酒精性脂肪肝病人群的诊断。患者（n = 253）是由临床，美国，及组织学（克莱纳得分）功能评估。使用M探针进行瞬时弹性。患者中低量的纤维化（F0-F1和F0-F2），中值LSM值，表示在千帕，均显著高于患有严重脂肪变性（在肝活检≥66％）相比，这些无（F0-F1 6.9与5.8，P = 0.04; F0-F2 7.4与6.0，P = 0.001），以及重症患者明亮肝回声模式对美国相比，他们的同行（F0-F1 7.3与5.6，P = 0.001; F0-F2 7.6与6.0，P <0.001）。受试者没有显著纤维化（F0-F1），并且没有严重纤维化（F0-F2），更高速率的假阳性结果的LSM，观察患者脂肪变性≥66％相比那些没有（F0-F1 23.6％比14.9 ％，F0-F2 33.3％和13.2％），并在患者相比，他们的同行在美国严重明亮肝回声模式（F0-F1 22.2％和15.4％，F0-F2 28.8％和15.6％）。结论：在患者的非酒精性脂肪肝疾病，严重的脂肪变性的存在下，通过组织学或通过美国检测，始终应考虑到，以避免肝纤维化的高估由瞬时弹性评估。 （肝病2015年; 62：1101-1110）