中度至重度肝脏脂肪变性导致高估慢性乙型肝炎患者肝硬度

StephenW

Aliment Pharmacol Ther. 2019 May 16. doi: 10.1111/apt.15298. [Epub ahead of print]
Moderate to severe hepatic steatosis leads to overestimation of liver stiffness measurement in chronic hepatitis B patients without significant fibrosis.
Shen F1, Mi YQ2, Xu L2, Liu YG2, Wang XY3, Pan Q1, Zhang RN1, Hu XQ4, Xu LM1, Fan JG1,5.
Author information
Abstract
BACKGROUND:

Liver stiffness measurement (LSM) by transient elastography is a noninvasive method for the diagnosis of hepatic fibrosis. The impact of hepatic steatosis on LSM remains to be explored.
AIM:

To determine whether LSM is affected by hepatic steatosis in patients with chronic hepatitis B (CHB).
METHODS:

Consecutive patients with biopsy-proven CHB were prospectively enrolled. Hepatic steatosis was classified by pathology as none (S0, <5%), mild (S1, 5%-33%), and moderate-severe (S2-3, >33%), and quantitatively by controlled attenuation parameter (CAP) as CAP S0 (≤247 dB/m), CAP S1 (248-267 dB/m) and CAP S2-3 (≥268 dB/m). Liver fibrosis was assessed by METAVIR classification and noninvasively by LSM.
RESULTS:

The prevalence of non-alcoholic fatty liver disease (n = 223) in CHB patients (n = 593) was 37.6%. Forty-eight belonged to S2-3 and 127 belonged to CAP S2-3. In patients without significant fibrosis (F0-1), the median LSM (kPa) was 7.4 in S2-3 and 7.1 in CAP S2-3, which was significantly higher than that in S0/S1 (P = 0.005) and CAP S0/S1 (P = 0.003). No significant difference was found in significant fibrosis (F2-4). For LSM identifying significant fibrosis (F2-4), the negative predictive value was higher in CHB patients with CAP ≥ 268 compared to those with CAP < 268 (0.81 vs 0.73); the positive predictive value was lower in CAP ≥ 268 than its counterpart (0.65 vs 0.76).
CONCLUSIONS:

Moderate-severe steatosis increased the LSM value in CHB patients without significant fibrosis. A CAP ≥ 268 did not affect LSM for ruling out, but it slightly affected LSM for ruling in significant fibrosis.
TRIAL REGISTRATION:

ChiCTR-DDT-13003983.

© 2019 John Wiley & Sons Ltd.

PMID:
    31094016
DOI:
    10.1111/apt.15298

StephenW

Aliment Pharmacol Ther。 2019年5月16日.doi：10.1111 / apt.15298。 [印刷前的电子版]
中度至重度肝脏脂肪变性导致高估慢性乙型肝炎患者肝硬度测量而无明显纤维化。
Shen F1，Mi YQ2，Xu L2，Liu YG2，Wang XY3，Pa​​n Q1，Zhang RN1，Hu XQ4，Xu LM1，Fan JG1,5。
作者信息
抽象
背景：

瞬态弹性成像的肝硬度测量（LSM）是一种诊断肝纤维化的非侵入性方法。肝脏脂肪变性对LSM的影响仍有待探索。
目标：

确定LSM是否受慢性乙型肝炎（CHB）患者肝脏脂肪变性的影响。
方法：

经活检证实的CHB的连续患者被前瞻性登记。肝脏脂肪变性按病理分类为无（S0，<5％），轻度（S1,5％-33％）和中度 - 重度（S2-3，> 33％），并通过受控衰减参数（CAP）定量作为CAP S0（≤247dB/ m），CAP S1（248-267 dB / m）和CAP S2-3（≥268dB/ m）。通过METAVIR分类和LSM非侵入性评估肝纤维化。
结果：

CHB患者（n = 593）中非酒精性脂肪肝（n = 223）的患病率为37.6％。四十八个属于S2-3，127属于CAP S2-3。在无明显纤维化（F0 -1）的患者中，中位数LSM（kPa）在S2-3中为7.4，在CAP S2-3中为7.1，显着高于S0 / S1（P = 0.005）和CAP S0 / S1（P = 0.003）。在显着纤维化（F2-4）中未发现显着差异。对于LSM鉴定显着纤维化（F2-4），CAP <268的CHB患者的阴性预测值高于CAP <268的患者（0.81对0.73）。阳性预测值在CAP≥268时低于其对应者（ 0.65对0.76）。
结论：

中度 - 严重脂肪变性增加了CHB患者的LSM值而没有明显的纤维化。 CAP≥268不会影响LSM的排除，但它对LSM在显着纤维化方面的影响略有影响。
试用注册：

ChiCTR简介-DDT-13003983。

©2019 John Wiley＆Sons Ltd.

结论：
31094016
DOI：
10.1111 / apt.15298

StephenW

https://onlinelibrary.wiley.com/doi/pdf/10.1111/apt.15298