瞬态弹性成像控制衰减参数的预后价值

StephenW

Prognostic Value of Controlled Attenuation Parameter by Transient Elastography

    Ken Liu MBBS, Vincent Wai-Sun Wong MD, Keith Lau, Sienna Du Liu MBBS, Yee-Kit Tse MPhill, Terry Cheuk-Fung Yip MPhill, Raymond Kwok MBBS, Alex Yiu-Wa Chan, Henry Lik-Yuen Chan MD & Grace Lai-Hung Wong MD

    The American Journal of Gastroenterology (2017) 112, 1812–1823 (2017)
    doi:10.1038/ajg.2017.389
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Received:
    24 May 2017
Accepted:
    12 September 2017
Published online:
    31 October 2017

Abstract
Objectives:

Liver stiffness measurement (LSM) by transient elastography (TE) has been shown to predict outcomes in patients with liver disease. While controlled attenuation parameter (CAP) measurement can accurately quantify hepatic steatosis, its prognostic value is unknown. We aim to determine if CAP is predictive for liver-related events (LRE), non-hepatocellular carcinoma (HCC) cancers, and cardiovascular events (CVE).
Methods:

Consecutive patients with both a reliable LSM and ≥10 successful CAP measurements by TE from August 2012 to March 2016 were included in the analysis. LRE were defined as HCC or hepatic decompensation. CVE were defined as acute coronary syndrome (ACS), cerebrovascular accident (CVA), or coronary intervention (stenting or bypass).
Results:

Of the 5,848 patients that were examined, 4,282 (56.7% male, median age 57 years) had adequate follow-up, reliable LSM (median 6.1 kPa), and ≥10 CAP measurements (median 250 dB/m). Indications for TE were: suspected non-alcoholic fatty liver disease (NAFLD) (40.7%), hepatitis B (HBV) (37.0%), hepatitis C (2.9%), and others (19.4%). During 8,540 patient-years of follow-up, there were 45 patients with LRE (34 HCC, 33 decompensations), 73 with newly diagnosed non-HCC cancers, and 65 with CVE (27 ACS, 25 CVA, and 35 coronary interventions). CAP did not predict LRE, non-HCC cancer, or CVE on univariate analysis. On multivariate analysis, LSM, male sex, platelet count, serum albumin, and HBV etiology independently predicted LRE; age was the only independent predictor of non-HCC cancer; while age, fasting blood glucose, total cholesterol, and creatinine predicted for CVE. Subgroup analyses of viral hepatitis and NAFLD patients revealed similar results.
Conclusion:

Neither the presence nor the severity of hepatic steatosis as measured by CAP predict LRE, cancer, or CVE in the short term.

StephenW

瞬态弹性成像控制衰减参数的预后价值

    Ken Liu MBBS，Vincent Wai-Sun Wong医学博士，Keith Lau，Sienna Du Liu MBBS，叶绮琪MPhill，叶澍锋MPhill，郭炳宪MBBS，陈耀华，陈绮贞MD＆Grace黄丽红博士

    美国胃肠病学杂志（2017）112,1812-1823（2017）
    DOI：10.1038 / ajg.2017.389
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收稿日期：
    2017年5月24日
公认：
    2017年9月12日
在线发布：
    2017年10月31日

抽象
目标：

已经显示通过瞬时弹性成像（TE）的肝硬度测量（LSM）可以预测肝病患者的结果。虽然控制衰减参数（CAP）的测量可以准确量化肝脂肪变性，其预后价值是未知的。我们的目标是确定CAP是否预测肝脏相关事件（LRE），非肝细胞癌（HCC）癌症和心血管事件（CVE）。
方法：

分析中包括2012年8月至2016年3月TE连续可靠的LSM患者以及TE成功进行CAP成功率≥10次的患者。 LRE定义为HCC或肝功能失代偿。 CVE被定义为急性冠状动脉综合征（ACS），脑血管意外（CVA）或冠脉介入（支架或旁路）。
结果：

在5,848例接受检查的患者中，4282例（男性56.7％，平均年龄57岁）有足够的随访，可靠的LSM（中位6.1 kPa）和≥10 CAP（中位数250 dB / m）。 TE的指征为：疑似非酒精性脂肪肝（NAFLD）（40.7％），乙型肝炎（HBV）（37.0％），丙型肝炎（2.9％）和其他人（19.4％）。随访8,540例患者中，45例LRE（34例HCC，33例失代偿），73例新诊断的非HCC癌，65例CVE（27例ACS，25例CVA，35例冠脉介入治疗）。在单变量分析中CAP不预测LRE，非HCC癌症或CVE。在多因素分析中，LSM，男性，血小板计数，血清白蛋白和HBV病因独立预测LRE;年龄是非HCC癌症的唯一独立预测因子;而年龄，空腹血糖，总胆固醇和肌酐预测为CVE。病毒性肝炎和NAFLD患者的亚组分析揭示了相似的结果。
结论：

由CAP测量的肝脂肪变性的存在或严重程度在短期内都不预测LRE，癌症或CVE。