EASL2019 THU-211 用声学方法评价点剪切波弹性成像 辐射力脉冲

StephenW

Internal Medicine II, Department of Gastroenterology, Wiesbaden,
Germany
Email: [email protected]
Background and aims: Transient elastography (TE) and point
shearwave elastography (pSWE) using acoustic radiation force
impulse (ARFI) imaging have been widely validated for the noninvasive
diagnosis of significant fibrosis (F ≥ 2) and cirrhosis in
patients with chronic liver disease. Patients with chronic HBeantigen-
negative HBV infection with persistently normal ALT and
HBV-DNA levels <2000 IU/ml represent a large group of patients with
mostly F0/F1 fibrosis who generally do not require antiviral
treatment. However, follow-up of these patients is crucial to early
detect fluctuating HBV-DNA and/or ALT levels and possible fibrosis
progression. The aim of this study was to prospectively assess,
whether pSWE represents a comparable diagnostic tool toTE for noninvasive
assessment of liver fibrosis progression in a longitudinal
cohort of untreated patients with HbeAg-negative chronic HBV
infection.
Method: 922 consecutive patients (302 males, mean age 42 ± 12
years) with HbeAg-negative HBV infection were prospectively
followed-up for 6 years. TE, pSWE as well as laboratory fibrosis
markers FIB-4 and APRI were performed at study inclusion and at
yearly intervals for 6 years. Patientswere classified into the following
3 groups: nALTnHBV (ALT within normal range, HBV DNA <2000 IU/
ml, n = 679), nALTeHBV (ALT within normal range, elevated HBV-DNA
between 2000 and 105 IU/ml, n = 95) and eALTnHBV (elevated ALT,
HBV-DNA <2000 IU/ml, n = 148).
Results: In the present study, pSWE results were significantly
correlated with TE (r = 0.292, p < 0.001) and APRI values (r = 0.197,
p < 0.001). Median ARFI values did not differ between eALTnHBV,
nALTeHBV and nALTnHBV (p = 0.43, p = 0.14, p = 0.05). However,
considering TE results, eALTnHBV had signficantly higher values
despite low HBV compared to nALTnHBV and nALTeHBV (p < 0.001).
In the 6 years of follow-up, median TE and pSWE values aswell as FIB-
4 and APRI values did not differ significantly from baseline values
(median intra-patient changes at the end of follow-up relative to
Baseline in nALTnHBV patients, TE: 0.75, p = 0.62; ARFI: 2.0, p = 0.62;
APRI: 0.5, p = 0.28; FIB-4: 0.17, p = 0.90).
Conclusion: This study shows that pSWE using ARFI imaging is a
reliable ultrasound-based method for the follow-up and the
assessment of liver fibrosis in HbeAg-negative chronic HBV infection.

StephenW

THU-211
用声学方法评价点剪切波弹性成像
辐射力脉冲成像用于非侵入性评估
HBeAg阴性慢性HBV感染的肝纤维化：A
前瞻性纵向研究
Christiana Graf1，Viola Knop1，Antonia Mondorf1，Kai-Henrik Peiffer1，
Stefan Zeuzem1，Christoph Sarrazin2，Johannes Vermehren1。
1法兰克福大学医院，内科I，系
德国法兰克福消化内科; 2ST。 Josefs医院Wiesbaden内科医学II，威斯巴登胃肠病学系，
德国
电子邮件：[email protected]
背景和目的：瞬态弹性成像（TE）和点
剪切波弹性成像（pSWE）使用声辐射力
脉冲（ARFI）成像已被广泛验证为非侵入性
诊断为明显纤维化（F≥2）和肝硬化
慢性肝病患者。慢性HBeantigen患者 -
ALV持续正常和HBV感染阴性
HBV-DNA水平<2000 IU / ml代表一大群患者
大多数F0 / F1纤维化患者一般不需要抗病毒药物
治疗。然而，这些患者的随访对于早期至关重要
检测波动的HBV-DNA和/或ALT水平以及可能的纤维化
进展。这项研究的目的是前瞻性评估，
pSWE是否代表了与非侵入性相似的诊断工具
评估肝纤维化的纵向进展
未治疗的HbeAg阴性慢性HBV患者队列
感染。
方法：连续922例患者（男性302例，平均年龄42±12岁）
与HbeAg阴性的HBV感染相关的前瞻性研究
随访6年。 TE，pSWE以及实验室纤维化
标志物FIB-4和APRI在研究纳入时和在
每年间隔6年。患者分为以下几类
3组：nALTnHBV（ALT在正常范围内，HBV DNA <2000 IU /
ml，n = 679），nALTeHBV（ALT在正常范围内，HBV-DNA升高
2000至105 IU / ml，n = 95）和eALTnHBV（ALT升高，
HBV-DNA <2000IU / ml，n = 148）。
结果：在本研究中，pSWE结果显着
与TE相关（r = 0.292，p <0.001）和APRI值（r = 0.197，
p <0.001）。 eALTnHBV的中位ARFI值没有差异，
nALTeHBV和nALTnHBV（p = 0.43，p = 0.14，p = 0.05）。然而，
考虑到TE结果，eALTnHBV的值明显较高
尽管与nALTnHBV和nALTeHBV相比HBV较低（p <0.001）。
在6年的随访中，中位数TE和pSWE值以及FIB-
4和APRI值与基线值没有显着差异
（随访结束时患者的中位数变化相对于
nALTnHBV患者的基线，TE：0.75，p = 0.62; ARFI：2.0，p = 0.62;
APRI：0.5，p = 0.28; FIB-4：0.17，p = 0.90）。
结论：本研究表明，使用ARFI成像的pSWE是一种
可靠的超声波检查方法，用于随访和随访
评估HbeAg阴性慢性HBV感染的肝纤维化。