CAP超声提供肝脏脂肪变性的无创测量

StephenW

CAP ultrasound provides noninvasive measurement of hepatic steatosis

Karlas T, et al. J Hepatol. 2017;doi:10.1016/j.jhep.2016.12.022.
April 19, 2017

Controlled attenuation parameter, or CAP, provided a standardized, noninvasive measure of hepatic steatosis, particularly when comorbid liver disease, BMI and diabetes were considered, according to a recently published meta-analysis.

“CAP measurement is an easy and fast examination providing a numerical value, which correlates with the histological degree of steatosis. It has been studied in more than 20 biopsy controlled studies which evaluated its correlation with histologically defined steatosis,” Thomas Karlas, MD, from the University Hospital of Leipzig, and colleagues wrote. “However, the routine use of CAP is limited due to uncertainty as to the optimal cut-off values between different steatosis grades and regarding the influence of different covariates. We conducted an individual patient data meta-analysis ... on CAP accuracy for non-invasive grading of liver steatosis.”

The researchers reviewed 19 studies containing histology verified CAP data and biopsy results of 2,735 eligible patient cases. Mean patient age was 45.5 years, 37.7% were female and mean BMI was 25 kg/m2. CAP was performed within one day of biopsy in 1,634 patients and in one week of biopsy in 2,685 patients.

The researchers determined the optimal cut-offs to be 248 dB/m (95% CI, 237-261) for steatosis grade greater than S0, 268 dB/m (95% CI, 257-284) for steatosis grade greater than S1, and 280 dB/m (95% CI, 268-294) for steatosis grade greater than S2. BMI, diabetes and etiology of liver disease had a significant and relevant influence on CAP.

Patients with NAFLD or NASH classified at steatosis grade S1 had approximately 5.2% (95% CI, 2.5-7.9) more affected hepatocytes than other etiologies. In patients with NAFLD or NASH at grade S2, the difference was only 3.6% (95% CI, 0.3-7), while there was no differential indication for grade S3.

Patients with NAFLD or NASH had increased CAP values of 16 dB/m (95% CI, 6-26) and patients with diabetes had an increased value of 13 dB/m (95% CI, 3-25). CAP values also increased by 3.9 dB/m (95% CI, 2.9-5) per BMI unit.

“Transient elastography has been an object of research for over 10 years now. Initially, it was seen primarily as a surrogate for fibrosis estimation, but liver stiffness gradually emerged as a distinct diagnostically relevant parameter reflecting disease severity and prognosis,” the researchers wrote. “Thinking of CAP, it is somewhat early to speculate about future applications, but an analogous progression is conceivable, especially considering the impact of steatosis on fibrosis progression in NAFLD patients.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.

StephenW

CAP超声提供肝脏脂肪变性的无创测量

Karlas T，et al。 J Hepatol 2017; doi：10.1016 / j.jhep.2016.12.022。
2017年4月19日

根据最近发表的荟萃分析，受控的衰减参数或CAP提供了肝脏脂肪变性的标准化，非侵入性测量，特别是在考虑了共患肝脏疾病，BMI和糖尿病时。

“CAP测量是一个容易和快速的检查，提供数值，这与脂肪变性的组织学程度相关。莱比锡大学医院的托马斯·卡拉斯（Thomas Karlas）博士和同事们写道：在20多个活组织检查对照研究中对其进行了研究，评估其与组织学上定义的脂肪变性的相关性。 “然而，CAP的常规使用是有限的，因为不确定性，不同脂肪变性等级之间的最佳临界值以及不同协变量的影响。我们对肝脏脂肪变性的非侵入性分级进行了个人患者数据荟萃分析。

研究人员回顾了19项包含组织学检查的CAP数据和2,735例合格患者病例活检结果的研究。平均患者年龄45.5岁，女性37.7％，平均体重指数25 kg / m2。在1,634例患者的活检一天内进行CAP，在2,685例患者中进行一周的活组织检查。

研究人员确定，对于脂肪变性等级大于S1的脂肪变性等级大于S0，268 dB / m（95％CI，257-284）的最佳临界值为248 dB / m（95％CI，237-261）和脂肪变性等级大于S2的280 dB / m（95％CI，268-294）。肝脏疾病的BMI，糖尿病和病因对CAP具有重要和相关的影响。

患有脂肪变性等级S1的NAFLD或NASH患者比其他病因更多地影响肝细胞的5.2％（95％CI，2.5-7.9）。在NAFLD或NASH在S2级患者中，差异仅为3.6％（95％CI，0.3-7），而S3级无差异性指标。

NAFLD或NASH患者的CAP值增加了16 dB / m（95％CI，6-26），糖尿病患者的增加值为13 dB / m（95％CI，3-25）。每个BMI单位的CAP值也增加3.9 dB / m（95％CI，2.9-5）。

“瞬态弹性成像已经是十多年来的研究对象。研究人员写道：最初，它被认为主要是纤维化估计的替代物，但肝硬化逐渐出现作为反映疾病严重程度和预后的独特诊断相关参数。 “考虑到CAP，推测未来应用程序有些早，但可以想到类似的进展，特别是考虑到脂肪变性对NAFLD患者纤维化进展的影响。” - Talitha Bennett

披露：研究人员报告没有相关的财务披露。