与非酒精性脂肪肝患者的配对肝活检相比，重复肝脏硬度测

StephenW

Hepatology International

January 2018, Volume 12, Issue 1, pp 44–55 | Cite as
Repeated liver stiffness measurement compared with paired liver biopsy in patients with non-alcoholic fatty liver disease

    Authors
    Authors and affiliations

    Sivesh K. KamarajahWah-Kheong ChanEmail authorNik Raihan Nik MustaphaSanjiv Mahadeva

    Sivesh K. Kamarajah        12
    Wah-Kheong Chan        1Email author
    Nik Raihan Nik Mustapha        3
    Sanjiv Mahadeva        1

    1.Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
    2.College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
    3.Department of PathologyHospital Sultanah BahiyahAlor SetarMalaysia

Original Article
First Online: 25 January 2018

    99 Downloads

Abstract
Introduction

The value of repeated liver stiffness measurement (LSM) in non-alcoholic fatty liver disease (NAFLD) has not been shown before.
Methods

A longitudinal study of biopsy-proven NAFLD patients was conducted at the Asian tertiary hospital from November 2012 to January 2017. Patients with paired liver biopsies and LSM were followed prospectively for liver-related and non-liver related complications, and survival.
Results

The data for 113 biopsy-proven NAFLD patients (mean age 51.3 ± 10.6 years, male 50%) were analyzed. At baseline, advanced fibrosis based on histology and LSM was observed in 22 and 46%, respectively. Paired liver biopsy and LSM at 1-year interval was available in 71 and 80% of patients, respectively. High-risk cases (defined as patients with advanced fibrosis at baseline who had no fibrosis improvement, and patients who developed advanced fibrosis on repeat assessment) were seen in 23 and 53% of patients, based on paired liver biopsy and LSM, respectively. Type 2 diabetes mellitus was independently associated with high-risk cases. The median follow-up was 37 months with a total follow-up of 328 person-years. High-risk cases based on paired liver biopsy had significantly higher rates of liver-related complications (p = 0.002) but no difference in other outcomes. High-risk patients based on paired LSM had a significantly higher rate of liver-related complications (p = 0.046), cardiovascular events (p = 0.025) and composite outcomes (p = 0.006).
Conclusion

Repeat LSM can predict liver-related complications, similar to paired liver biopsy, and may be useful in identifying patients who may be at an increased risk of cardiovascular events. Further studies in a larger cohort and with a longer follow-up should be carried out to confirm these observations.
Keywords
Liver fibrosis Cirrhosis Fibroscan Liver biopsy NAFLD

StephenW

国际肝病学

2018年1月，第12卷，第1期，第44-55页|引用为
与非酒精性脂肪肝患者的配对肝活检相比，重复肝脏硬度测量

    作者
    作者和从属关系

    Sivesh K. KamarajahWah-Kheong Chan电邮作者尼日利亚Nik MustaphaSanjiv Mahadeva

    Sivesh K. Kamarajah 12
    Wah-Kheong Chan 1电子邮件作者
    Nik Raihan Nik Mustapha 3
    Sanjiv Mahadeva 1

    1.马来亚大学医学院医学系胃肠病学和肝病学专业马来西亚吉隆坡马来西亚
    英国伯明翰伯明翰大学医学和牙科学院
    3.病理科Hospital Sultanah BahiyahAlor SetarMalaysia

来源文章
首次在线：2018年1月25日

    99下载

抽象
介绍

以前没有显示非酒精性脂肪性肝病（NAFLD）的重复肝脏硬度测量值（LSM）的值。
方法

2012年11月至2017年1月在亚洲三级医院进行了活检证实的NAFLD患者的纵向研究。对肝脏活检和LSM配对的患者进行前瞻性随访，观察肝脏相关和非肝脏相关并发症和生存情况。
结果

对113例活检证实的NAFLD患者的数据进行分析（平均年龄51.3±10.6岁，男性50％）。在基线时，分别观察到基于组织学和LSM的晚期纤维化，分别为22％和46％。 71％和80％的患者分别在1年的时间间隔配对肝活检和LSM。根据配对肝活检和LSM分析，高风险病例（定义为基线时没有纤维化改善的患者，以及重复评估时发生晚期纤维化的患者）分别有23％和53％的患者出现。 2型糖尿病与高危病例独立相关。中位随访时间为37个月，总共随访328人年。基于配对肝活检的高危病例的肝脏并发症发生率明显较高（p = 0.002），但其他结局无差异。基于配对LSM的高危患者肝脏相关并发症（p = 0.046），心血管事件（p = 0.025）和复合结局（p = 0.006）的发生率明显较高。
结论

重复LSM可以预测肝脏相关并发症，类似于配对的肝脏活检，并且可能有助于确定可能会增加心血管事件风险的患者。应进一步研究更大的队列和更长的随访期以确认这些观察结果。
关键词
肝纤维化肝硬化Fibroscan肝活组织检查NAFLD