非酒精性脂肪性肝病中M和XL探针对肝硬度测量的统一解释

StephenW

Unified interpretation of liver stiffness measurement by M and XL probes in non-alcoholic fatty liver disease

    Vincent Wai-Sun Wong1,2, Marie Irles3, Grace Lai-Hung Wong1,2, Sarah Shili3, Anthony Wing-Hung Chan4, Wassil Merrouche3, Sally She-Ting Shu1,2, Juliette Foucher3, Brigitte Le Bail5,6, Wah Kheong Chan7, Henry Lik-Yuen Chan1,2, Victor de Ledinghen3,6

Author affiliations

    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
    State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
    Centre d’Investigation de la Fibrose Hépatique, Bordeaux University Hospital, Pessac, France
    Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, New Territories, Hong Kong
    Pathology Unit, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
    INSERM U1053, Bordeaux University, Bordeaux, France
    Department of Medicine, Gastroenterology and Hepatology Unit, University of Malaya, Kuala Lumpur, Malaysia

    Correspondence to Dr Vincent Wai-Sun Wong, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; [email protected] and Prof Victor de Ledinghen, Centre d’Investigation de la Fibrose Hépatique, Service d’Hépato-Gastroentérologie, Hôpital Haut-Lévêque, 33604 Pessac, France; [email protected]

Abstract

Objective The latest model of vibration-controlled transient elastography (VCTE) automatically selects M or XL probe according to patients’ body built. We aim to test the application of a unified interpretation of VCTE results with probes appropriate for the body mass index (BMI) and hypothesise that this approach is not affected by hepatic steatosis.

Design We prospectively recruited 496 patients with non-alcoholic fatty liver disease who underwent VCTE by both M and XL probes within 1 week before liver biopsy.

Results 391 (78.8%) and 433 (87.3%) patients had reliable liver stiffness measurement (LSM) (10 successful acquisitions and IQR:median ratio ≤0.30) by M and XL probes, respectively (p<0.001). The area under the receiver operating characteristic curves was similar between the two probes (0.75–0.88 for F2–4, 0.83–0.91 for F4). When used in the same patient, LSM by XL probe was lower than that by M probe (mean difference 2.3 kPa). In contrast, patients with BMI ≥30 kg/m2 had higher LSM regardless of the probe used. When M and XL probes were used in patients with BMI <30 and ≥30 kg/m2, respectively, they yielded nearly identical median LSM at each fibrosis stage and similar diagnostic performance. Severe steatosis did not increase LSM or the rate of false-positive diagnosis by XL probe.

Conclusion High BMI but not severe steatosis increases LSM. The same LSM cut-offs can be used without further adjustment for steatosis when M and XL probes are used according to the appropriate BMI.
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http://dx.doi.org/10.1136/gutjnl-2018-317334

StephenW

非酒精性脂肪性肝病中M和XL探针对肝硬度测量的统一解释

    黄文顺1,2，玛丽·艾勒斯3，黄丽红1,2，莎拉·史莉3，Anthony Wing-Hung Chan4，瓦西尔·梅鲁奇3，莎莉·舒汀·舒1,2，朱丽叶·福克斯3，碧姬·李保尔5,6，华W Chan7，李力源Chan1,2，Victor de Ledinghen3,6

作者单位

    香港中文大学医学与治疗学系，香港，中国
    香港中文大学消化系统疾病国家重点实验室，香港，中国
    法国佩萨克波尔多大学医院纤维肝研究中心
    香港中文大学，新界解剖与细胞病理学系
    法国波尔多波尔多大学医院HôpitalPellegrin病理科
    INSERM U1053，波尔多大学，法国波尔多
    马来西亚吉隆坡马来亚大学医学，肠胃病和肝病学系

    香港中文大学医学与治疗学系黄文新博士的通讯[email protected]和Victor de Ledinghen教授，法国HôpitalHaut-Lévêque赫帕托·胃肠病学研究中心纤维研究中心，法国佩萨克，33604； [email protected]

抽象

目的最新的振动控制瞬态弹性成像（VCTE）模型会根据患者的身体状况自动选择M或XL探头。我们旨在通过适用于体重指数（BMI）的探针测试VCTE结果的统一解释的应用，并假设这种方法不受肝脂肪变性的影响。

设计我们前瞻性地招募了496例非酒精性脂肪肝患者，他们在肝活检前1周内通过M和XL探针均接受了VCTE手术。

结果分别有391例（78.8％）和433例（87.3％）的患者通过M和XL探针进行了可靠的肝硬度测量（LSM）（成功采集10次，IQR：中位比≤0.30）（p <0.001）。两个探头之间的接收器工作特性曲线下的面积相似（F2-4的0.75-0.88，F4的0.83-0.91）。当在同一患者中使用时，XL探针的LSM低于M探针的LSM（平均差为2.3 kPa）。相比之下，BMI≥30Bkg / m2的患者无论使用哪种探针都具有较高的LSM。当M和XL探针分别用于BMI <30和≥30kg / m2的患者时，在每个纤维化阶段它们产生的LSM中值几乎相同，并且诊断性能相似。严重脂肪变性不会增加LSM或XL探针的假阳性诊断率。

结论高BMI而非严重脂肪变性可增加LSM。当根据适当的BMI使用M和XL探针时，可以使用相同的LSM截止值而无需进一步调整脂肪变性。
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http://dx.doi.org/10.1136/gutjnl-2018-317334