慢性乙型肝炎精确的纤维化分期和剪切波弹性成像取决于肝

StephenW

Precise fibrosis staging with shear wave elastography in chronic hepatitis B depends on liver inflammation and steatosis

    Junzhao Ye, Wei Wang, Shiting Feng, Yang Huang, Xianhua Liao, Ming Kuang, Xiaoyan Xie, Bing Liao & Bihui Zhong

Hepatology International volume 14, pages190–201(2020)Cite this article

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Abstract
Background

Two-dimensional shear wave elastography (2D-SWE) is the latest generation of ultrasound elastography for the non-invasive assessment of liver fibrosis in chronic hepatitis B (CHB). We aimed to identify confounders of 2D-SWE in fibrosis grading.
Methods

A prospective cohort of 440 CHB patients (286 with liver biopsy and 154 with clinical decompensated cirrhosis) was consecutively enrolled from a clinical trial (registration number: ChiCTR-DCD-15006000) aimed at optimizing 2D-SWE assessments from 2015 to 2018. All patients underwent 2D-SWE examination, anthropometric measurement, and serum biomarker assessment. Steatosis was graded by the magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF).
Results

Overall, the prevalence of incorrect fibrosis staging by 2D-SWE was 26.1% (n = 115), with 43.5% of patients under-staged and 56.5% over-staged. In multivariate analysis, the steatosis degree was an independent predictor of 2D-SWE discordance in the overall cohort, with moderate–severe steatosis for underestimation (odds ratio, [OR] = 4.3, 95% confidence interval [CI] 1.2–18.2, p = 0.049) and overestimation (OR = 8.2, 95% CI 2.9–23.5, p < 0.001), and mild steatosis for overestimation (OR = 3.7, 95% CI 1.5–9.0, p = 0.004). In patients with liver biopsy, both histological inflammation activity over 2 (OR = 5.0, 95% CI 2.0–25.3, p = 0.048) and moderate–severe steatosis (OR = 5.2, 95% CI 2.1–13.4, p < 0.001) were independent factors associated with discordance. For the risk of 2D-SWE mis-staging, a nomogram that integrated these confounders was established and the area under the receiver operating characteristic curve of the model was 0.861.
Conclusions

Steatosis and inflammation activities were confounders for 2D-SWE. The combination of these confounders could predict mis-staging risks of CHB-related fibrosis with 2D-SWE and may be valuable to decision-making on liver biopsy for fibrosis staging.

StephenW

慢性乙型肝炎精确的纤维化分期和剪切波弹性成像取决于肝脏炎症和脂肪变性

叶俊钊，王伟，冯士廷，黄扬，廖宪华，明匡，谢晓燕，廖冰，毕碧辉

国际肝病杂志第14卷，第190-201页（2020年）

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抽象
背景

二维剪切波弹性成像（2D-SWE）是最新一代的超声弹性成像，可用于无创评估慢性乙型肝炎（CHB）肝纤维化。我们旨在确定纤维化分级中2D-SWE的混杂因素。
方法

一项临床试验（注册号：ChiCTR-DCD-15006000）连续纳入了440名CHB患者（286名肝活检和154名临床失代偿性肝硬化）的预期队列，旨在优化2015年至2018年的2D-SWE评估。所有患者进行了2D-SWE检查，人体测量和血清生物标志物评估。脂肪变性由磁共振成像衍生的质子密度脂肪分数（MRI-PDFF）分级。
结果

总体而言，通过2D-SWE进行的不正确纤维化分期的患病率为26.1％（n = 115），其中43.5％的患者处于分期不足，56.5％的患者处于分期。在多变量分析中，脂肪变性程度是总体队列中2D-SWE不一致性的独立预测因子，中度至重度脂肪变性可低估（优势比，[OR] = 4.3，95％置信区间[CI] 1.2-18.2，p = 0.049）和高估（OR = 8.2，95％CI 2.9-23.5，p <0.001），以及轻度脂肪变性导致的高估（OR = 3.7，95％CI 1.5-9.0，p = 0.004）。肝活检患者的组织学炎症活动均超过2（OR = 5.0，95％CI 2.0–25.3，p = 0.048）和中度至重度脂肪变性（OR = 5.2，95％CI 2.1–13.4，p <0.001）与不一致有关的独立因素。为了避免2D-SWE阶段错误的风险，建立了将这些混杂因素整合在一起的诺模图，该模型的接收器工作特性曲线下的面积为0.861。
结论

脂肪变性和炎症活动是2D-SWE的混杂因素。这些混杂因素的组合可以预测CHD相关纤维化与2D-SWE的错误分期风险，并且对于肝活检中纤维化分期的决策可能有价值。