用于诊断新加坡慢性肝病中显着纤维化和肝硬化的最佳肝硬

StephenW

Singapore Med J. 2018 Dec 17. doi: 10.11622/smedj.2018156. [Epub ahead of print]
Optimal liver stiffness measurement values for the diagnosis of significant fibrosis and cirrhosis in chronic liver disease in Singapore.
Chang PE1,2, Hartono JL3, Ngai YL1, Dan YY3, Lim KB3, Chow WC1,2.
Author information

1
    Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
2
    Duke-NUS Medical School, Singapore.
3
    Division of Gastroenterology and Hepatology, National University Hospital, Singapore.

Abstract
INTRODUCTION:

Despite the widespread use of transient elastography for non-invasive assessment of liver fibrosis, the optimal cut-off liver stiffness measurement (LSM) values remain unclear. This study aimed to validate the optimal cut-off LSM values for significant fibrosis and cirrhosis in patients with chronic liver disease (CLD).
METHODS:

Prospective multicentre data of CLD patients who underwent paired liver biopsy and LSM was analysed to determine the optimal cut-off LSM values for predicting significant fibrosis (METAVIR F ≥ 2) and cirrhosis (METAVIR F4). A high-quality cohort was selected by excluding those with failed LSM and invalid LSM readings.
RESULTS:

Of the 481 patients recruited, 322 fulfilled the pre-defined quality criteria. CLD aetiology was chronic hepatitis B (CHB) in 49%, non-alcoholic steatohepatitis (NASH) in 16% and chronic hepatitis C (CHC) in 12%. Area under the receiver operating characteristic curve for LSM was 0.775 (95% confidence interval [CI] 0.724-0.826) for significant fibrosis and 0.810 (95% CI 0.738-0.882) for cirrhosis. Optimal cut-off LSM values were 9 kPa for significant fibrosis and 13 kPa for cirrhosis in the general cohort. Optimal cut-off LSM values were 9 kPa for significant fibrosis and 12 kPa for cirrhosis for both CHB and CHC, while the corresponding values for NASH were 11 kPa and 15 kPa.
CONCLUSION:

Optimal cut-off LSM values should be selected based on disease aetiology. In Singapore, the optimal cut-off LSM values for CHB and CHC are 9 kPa for significant fibrosis and 12 kPa for cirrhosis. Optimal cut-off values for NASH require further validation.
KEYWORDS:

cirrhosis; cut-off; fibrosis; liver stiffness; transient elastography

PMID:
    30556091
DOI:
    10.11622/smedj.2018156

StephenW

新加坡Med J. 2018年12月17日doi：10.11622 / smedj.2018156。 [提前打印]
用于诊断新加坡慢性肝病中显着纤维化和肝硬化的最佳肝硬度测量值。
Chang PE1,2，Hartono JL3，Ngai YL1，Dan YY3，Lim KB3，Chow WC1,2。
作者信息

1
    新加坡新加坡综合医院消化内科和肝病学系。
2
    Duke-NUS医学院，新加坡。
3
    新加坡国立大学医院消化内科和肝病科。

抽象
介绍：

尽管瞬态弹性成像广泛用于肝纤维化的非侵入性评估，但最佳截止肝硬度测量（LSM）值仍不清楚。本研究旨在验证慢性肝病（CLD）患者中显着纤维化和肝硬化的最佳截止LSM值。
方法：

对接受配对肝活检和LSM的CLD患者的前瞻性多中心数据进行分析，以确定预测显着纤维化（METAVIRF≥2）和肝硬化（METAVIR F4）的最佳截止LSM值。通过排除LSM失败和LSM读数无效的人群，选择了高质量的队列。
结果：

在招募的481名患者中，322名符合预定的质量标准。 CLD病因是慢性乙型肝炎（CHB）占49％，非酒精性脂肪性肝炎（NASH）占16％，慢性丙型肝炎（CHC）占12％。对于显着纤维化，LSM的受试者操作特征曲线下面积为0.775（95％置信区间[CI] 0.724-0.826），肝硬化为0.810（95％CI 0.738-0.882）。对于显着纤维化，最佳截止LSM值为9kPa，对于一般群组中的肝硬化，最佳截止LSM值为13kPa。对于CHB和CHC，最佳截止LSM值显着纤维化为9kPa，肝硬化为12kPa，而NASH的相应值为11kPa和15kPa。
结论：

应根据疾病病因选择最佳截止LSM值。在新加坡，CHB和CHC的最佳截止LSM值对于显着的纤维化是9kPa，对于肝硬化是12kPa。 NASH的最佳截止值需要进一步验证。
关键词：

肝硬化;隔断;纤维化;肝硬度;瞬态弹性成像

结论：
    30556091
DOI：
    10.11622 / smedj.2018156