肝硬度测量可以反映出慢性肝病人群中活跃的肝坏死炎症：

StephenW

J Clin Transl Hepatol. 2019 Dec 28;7(4):313-321. doi: 10.14218/JCTH.2019.00040. Epub 2019 Dec 11.
Liver Stiffness Measurement Can Reflect the Active Liver Necroinflammation in Population with Chronic Liver Disease: A Real-world Evidence Study.
Wang L1, Zhu M2, Cao L3, Yao M4, Lu Y5, Wen X1, Zhang Y6, Ning J1, Long H7, Zhu Y8, Hu G9, Dang S10, Fu Q11, Chen L12, Zhang X2, Zhao J13, Gao Z7, Nan Y6, Lu F1,14.
Author information

1
    Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
2
    Department of Infectious Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
3
    Liver Disease Center, Qinhuangdao Third Hospital, Qinhuangdao, Hebei, China.
4
    Department of Anatomy and Embryology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
5
    Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
6
    Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
7
    Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
8
    Liver Research Center, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
9
    Department of Infectious Diseases, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
10
    Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
11
    Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, China.
12
    Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
13
    Department of Pathology and Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China.
14
    Intervention and Cell Therapy Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.

Abstract

Background and Aims: Non-invasive evaluation of liver necroinflammation in patients with chronic liver disease is an unmet need in clinical practice. The diagnostic accuracy of transient elastography-based liver stiffness measurement (LSM) for liver fibrosis could be affected by liver necroinflammation, the latter of which could intensify stiffness of the liver. Such results have prompted us to explore the diagnosis potential of LSM for liver inflammation. Methods: Three cross-sectional cohorts of liver biopsy-proven chronic liver disease patients were enrolled, including 1417 chronic hepatitis B (CHB) patients from 10 different medical centers, 106 non-alcoholic steatohepatitis patients, and 143 patients with autoimmune-related liver diseases. Another longitudinal cohort of 14 entecavir treatment patients was also included. The receiver operating characteristic (ROC) curve was employed to explore the diagnostic value of LSM. Results: In CHB patients, LSM value ascended with the increased severity of liver necroinflammation in patients with the same fibrosis stage. Such positive correlation between LSM and liver necroinflammation was also found in non-alcoholic steatohepatitis and autoimmune-related liver diseases populations. Furthermore, the ROC curve exhibited that LSM could identify moderate and severe inflammation in CHB patients (area under the ROC curve as 0.779 and 0.838) and in non-alcoholic steatohepatitis patients (area under the ROC curve as 0.826 and 0.871), respectively. Such moderate diagnostic value was also found in autoimmune-related liver diseases patients. In addition, in the longitudinal entecavir treated CHB cohort, a decline of LSM values was observed in parallel with the control of inflammatory activity in liver. Conclusions: Our study implicates a diagnostic potential of LSM to evaluate the severity of liver necroinflammation in chronic liver disease patients.

© 2019 Authors.
KEYWORDS:

Alanine aminotransferase; Chronic liver disease; Liver necroinflammatory grade; Liver stiffness measurement

PMID:
    31915600
PMCID:
    PMC6943212
DOI:
    10.14218/JCTH.2019.00040

StephenW

J临床翻译肝素。 2019十二月28; 7（4）：313-321。 doi：10.14218 / JCTH.2019.00040。 Epub 2019十二月11。
肝硬度测量可以反映出慢性肝病人群中活跃的肝坏死炎症：一项现实世界的证据研究。
王L1，朱M2，曹L3，姚M4，陆Y5，文X1，张Y6，宁J1，长H7，朱Y8，胡G9，党S10，傅Q11，陈L12，张X2，赵J13，高Z7 ，南Y6，鲁F1,14。
作者信息

1个
    北京大学医学部基础医学学院微生物与传染病中心，北京
2
    上海交通大学医学院附属瑞金医院传染病科，上海
3
    秦皇岛市第三医院肝病中心，河北秦皇岛。
4
    北京大学健康科学中心基础医学院解剖与胚胎学教研室，北京
5
    美国北卡罗来纳大学教堂山分校，北卡罗来纳大学埃舍尔曼药学院。
6
    河北医科大学第三医院中西医结合肝病科，河北石家庄
7
    中山大学附属第三医院感染科，广东广州
8
    福建医科大学附属第一医院肝脏研究中心，福建福州。
9
    北京大学深圳医院传染病科，广东深圳。
10
    西安交通大学医学院附属第二医院感染科，陕西西安
11
    南京军区第85医院上海肝病研究中心，上海
12
    复旦大学上海公共卫生临床中心肝病科，上海
13
    解放军总医院第五医学中心病理与肝病科，北京。
14
    北京大学深圳医院介入与细胞治疗中心，广东深圳。

抽象

背景与目的：慢性肝病患者肝坏死性炎症的非侵入性评估是临床实践中未满足的需求。短暂性基于弹性成像的肝硬度测定（LSM）对肝纤维化的诊断准确性可能会受到肝脏坏死性炎症的影响，后者会增强肝脏的僵硬性。这些结果促使我们探索LSM对肝炎的诊断潜力。方法：纳入三个经肝活检证实的慢性肝病患者的横断队列，包括来自10个不同医学中心的1417例慢性乙型肝炎（CHB）患者，106例非酒精性脂肪性肝炎患者和143例自身免疫相关性肝病患者。还包括另外14名恩替卡韦治疗患者的纵向队列。采用接收机工作特性曲线来探讨LSM的诊断价值。结果：在CHB患者中，在相同纤维化阶段的患者中，随着肝脏坏死性炎症的严重程度增加，LSM值升高。在非酒精性脂肪性肝炎和自身免疫相关的肝病人群中也发现了LSM与肝脏坏死性炎症之间的这种正相关。此外，ROC曲线显示LSM可以分别在CHB患者（ROC曲线下的区域为0.779和0.838）和非酒精性脂肪性肝炎患者（ROC曲线下的区域为0.826和0.871）中识别中度和重度炎症。在自身免疫相关的肝病患者中也发现了这种中等诊断价值。此外，在纵向恩替卡韦治疗的CHB队列中，观察到LSM值下降，同时控制了肝脏的炎症活性。结论：我们的研究表明LSM具有诊断慢性肝病患者肝坏死性炎症严重程度的诊断潜力。

©2019作者。
关键字：

丙氨酸氨基转移酶；慢性肝病；肝坏死程度；肝硬度测量

PMID：
    31915600
PMCID：
    PMC6943212
DOI：
    10.14218 / JCTH.2019.00040

StephenW

http://publine.xiahepublishing.c ... JCTH.2019.00040.pdf