肝炎对FibroScan装置评估慢性乙型肝炎病毒感染患者肝纤维化

StephenW

Effect of liver inflammation on accuracy of FibroScan device in assessing liver fibrosis stage in patients with chronic hepatitis B virus infection
Ling-Ling Huang  1 , Xue-Ping Yu  2 , Ju-Lan Li  2 , Hui-Ming Lin  1 , Na-Ling Kang  1 , Jia-Ji Jiang  1 , Yue-Yong Zhu  1 , Yu-Rui Liu  1 , Da-Wu Zeng  3
Affiliations
Affiliations

    1
    Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China.
    2
    Department of Infectious Diseases, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China.
    3
    Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China. [email protected].

    PMID: 33642834 PMCID: PMC7901051 DOI: 10.3748/wjg.v27.i7.641

Free PMC article
Abstract

Background: Transient elastography (FibroScan) is a new and non-invasive test, which has been widely recommended by the guidelines of chronic hepatitis B virus (HBV) management for assessing hepatic fibrosis staging. However, some confounders may affect the diagnostic accuracy of the FibroScan device in fibrosis staging.

Aim: To evaluate the diagnostic value of the FibroScan device and the effect of hepatic inflammation on the accuracy of FibroScan in assessing the stage of liver fibrosis in patients with HBV infection.

Methods: The data of 416 patients with chronic HBV infection who accepted FibroScan, liver biopsy, clinical, and biological examination were collected from two hospitals retrospectively. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic performance of FibroScan for assessing the stage of liver fibrosis. Any discordance in fibrosis staging by FibroScan and pathological scores was statistically analyzed. Logistic regression and ROC analyses were used to analyze the accuracy of FibroScan in assessing the stage of fibrosis in patients with different degrees of liver inflammation. A non-invasive model was constructed to predict the risk of misdiagnosis of fibrosis stage using FibroScan.

Results: In the overall cohort, the optimal diagnostic values of liver stiffness measurement (LSM) using FibroScan for significant fibrosis (≥ F2), severe fibrosis (≥ F3), and cirrhosis (F4) were 7.3 kPa [area under the curve (AUC) = 0.863], 9.7 kPa (AUC = 0.911), and 11.3 kPa (AUC = 0.918), respectively. The rate of misdiagnosis of fibrosis stage using FibroScan was 34.1% (142/416 patients). The group of patients who showed discordance between fibrosis staging using FibroScan and pathological scores had significantly higher alanine aminotransferase and aspartate aminotransferase levels, and a higher proportion of moderate to severe hepatic inflammation, compared with the group of patients who showed concordance in fibrosis staging between the two methods. Liver inflammation activity over 2 (OR = 3.53) was an independent risk factor for misdiagnosis of fibrosis stage using FibroScan. Patients with liver inflammation activity ≥ 2 showed higher LSM values using FibroScan and higher rates of misdiagnosis of fibrosis stage, whereas the diagnostic performance of FibroScan for different fibrosis stages was significantly lower than that in patients with inflammation activity < 2 (all P < 0.05). A non-invasive prediction model was established to assess the risk of misdiagnosis of fibrosis stage using FibroScan, and the AUC was 0.701.

Conclusion: Liver inflammation was an independent risk factor affecting the diagnostic accuracy of FibroScan for fibrosis stage. A combination of other related non-invasive factors can predict the risk of misdiagnosis of fibrosis staging using FibroScan.

Keywords: FibroScan; Fibrosis stage; Hepatitis B virus; Liver inflammation; Liver stiffness measurement; Predictive model.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

StephenW

肝炎对FibroScan装置评估慢性乙型肝炎病毒感染患者肝纤维化分期的准确性的影响
黄玲玲1，俞雪萍2，李聚兰2，林慧明1，康娜玲1，姜嘉吉1，朱跃勇1，刘玉瑞1，大达武增3
隶属关系
隶属关系

    1个
    福建医科大学附属第一医院肝病研究所肝病科，福建福州350005。
    2个
    福建医科大学附属泉州第一医院传染病科，福建泉州362000。
    3
    福建医科大学附属第一医院肝病研究所肝病科，福建福州350005。 [email protected]。

    PMID：33642834 PMCID：PMC7901051 DOI：10.3748 / wjg.v27.i7.641

免费PMC文章
抽象的

背景：瞬时弹性成像（FibroScan）是一种新的非侵入性测试，已被慢性乙型肝炎病毒（HBV）管理指南广泛推荐用于评估肝纤维化分期。但是，某些混杂因素可能会影响FibroScan设备在纤维化分期中的诊断准确性。

目的：评估FibroScan设备的诊断价值以及肝炎对FibroScan在评估HBV感染患者肝纤维化分期中的准确性的影响。

方法：回顾性收集两家医院的416例慢性乙型肝炎病毒感染患者的资料，这些患者接受了FibroScan，肝活检，临床和生物学检查。接收者操作特征（ROC）曲线用于分析FibroScan评估肝纤维化阶段的诊断性能。对通过FibroScan和病理评分得出的纤维化分期的任何不一致进行统计分析。使用Logistic回归和ROC分析来分析FibroScan在评估不同程度的肝脏炎症患者纤维化分期中的准确性。使用FibroScan构建了非侵入性模型来预测纤维化阶段误诊的风险。

结果：在整个队列中，使用FibroScan对严重纤维化（≥F2），严重纤维化（≥F3）和肝硬化（F4）进行肝硬度测量（LSM）的最佳诊断值为7.3 kPa [曲线下面积（AUC） ）= 0.863]，9.7 kPa（AUC = 0.911）和11.3 kPa（AUC = 0.918）。使用FibroScan进行的纤维化分期误诊率为34.1％（142/416例）。与FibroScan纤维化分期一致的患者相比，使用FibroScan进行纤维化分期与病理评分不一致的患者组的丙氨酸转氨酶和天冬氨酸转氨酶水平显着更高，中度至重度肝炎的比例更高。两种方法。使用FibroScan对肝纤维化分期进行误诊的肝炎症活动度超过2（OR = 3.53）是一个独立的危险因素。肝炎症活动度≥2的患者使用FibroScan表现出更高的LSM值，且纤维化分期的误诊率更高，而FibroScan对不同纤维化分期的诊断性能显着低于炎症活动度<2的患者（所有P <0.05） 。建立了非侵入性预测模型以使用FibroScan评估纤维化分期的误诊风险，AUC为0.701。

结论：肝脏炎症是影响FibroScan对纤维化阶段诊断准确性的独立危险因素。其他相关的非侵入性因素的组合可以预测使用FibroScan对纤维化分期进行误诊的风险。

关键字：FibroScan；纤维化阶段；乙型肝炎病毒;肝炎；肝硬度测量；预测模型。

©2021年作者。百世登出版集团有限公司出版。保留所有权利。

StephenW

https://www.wjgnet.com/1007-9327/full/v27/i7/641.htm