控制衰减参数对肝硬度测量检测纤维化的影响

StephenW

Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement
Authors

    First published: 15 February 2018Full publication history
    DOI: 10.1111/apt.14529  View/save citation
    Cited by (CrossRef): 0 articles Check for updates

    Article has an altmetric score of 1
    Funding Information

    The Handling Editor for this article was Professor Stephen Harrison, and it was accepted for publication after full peer-review.
    T. Karlas and D. Petroff contributed equally to this work.
    The names and full addresses of the International CAP-IPDMA group are listed in Appendix 1.

Summary
Background

Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis.
Aim

To determine how to use CAP in interpreting liver stiffness measurements.
Methods

This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP.
Results

Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis.
Conclusions

Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

StephenW

控制衰减参数对肝硬度测量检测纤维化的影响
作者

    首次出版：2018年2月15日完整的出版历史
    DOI：10.1111 / apt.14529查看/保存引文
    引用（CrossRef）：0文章检查更新

    文章的对等评分为1
    资金信息

    本文的处理编辑是Stephen Harrison教授，在完全同行评审后被接受发表。
    T. Karlas和D. Petroff对这项工作同样做出了贡献。
    附录1列出了国际CAP-IPDMA组的名称和完整地址。

概要
背景

肝纤维化常伴有脂肪变性，尤其是非酒精性脂肪性肝病（NAFLD）患者，其非侵入性表征尤为重要。振动控制瞬态弹性成像是非侵入性的选择方法;然而，最近的研究表明，脂肪变性可能会影响其诊断性能。控制衰减参数（CAP）添加到瞬态弹性成像可同时评估脂肪变性和纤维化。
目标

确定如何使用CAP来解释肝硬度测量。
方法

这是对来自CAP患者个体数据荟萃分析数据的二次分析。目前分析的主要排除标准是未知的病因，不可靠的弹性成像测量和已经用于相同研究问题的数据。确定病因学特异性肝硬度测量截止值，并用逻辑回归作为CAP的函数来估计阳性和阴性预测值（PPV / NPV）。
结果

256名患者符合纳入标准（37％女性，18％NAFLD / NASH，42％HBV，40％HCV，51％显着纤维化≥F2）。 Youden优化截止值仅足以排除肝硬化（NPV为98％）。通过灵敏度和特异性优化的临界值，排除显着纤维化的NPV是中等的（70％），并且通过考虑CAP可以稍微改善。尽管针对肝硬化的特异性优化截止值，但显着纤维化和肝硬化的PPV分别为68％和55％。
结论

低于病因特异性截断值的肝硬度测量值对于排除肝硬化非常有用，对于排除显着纤维化的程度较小。对于后者，控制衰减参数可以稍微改善解释。即使临界值非常高，肝硬度测量对于治疗纤维化或肝硬化也不是很可靠。

StephenW

http://onlinelibrary.wiley.com/doi/10.1111/apt.14529/full