LSM detects undiagnosed chronic liver disease

StephenW

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LSM detects undiagnosed chronic liver disease
Published date :24-Dec-2010

MedWire News: Study findings show that liver stiffness measurement (LSM) can
detect undiagnosed chronic liver disease in apparently healthy individuals, with
the added benefit of a 100% positive predictive value for cirrhosis screening.

"So far, liver biopsy has been the gold standard for the assessment of fibrosis
in patients with chronic liver disease," say Dominique Roulot (Avicenne
Hospital, Bobigny, France) and co-authors.

"However, in cases of suspicion of non-alcoholic fatty liver disease (NAFLD),
liver biopsy is difficult to recommend for apparently healthy patients with
normal liver tests, because of its possible complications," they add.

A total of 1190 individuals from the general population, aged 45 years or older,
attending for a medical check-up participated in the current study. All patients
received LSM, in addition to laboratory tests and medical examinations. Those
who scored over 8 kPa on the LSM were referred to a liver unit for further
investigations.

Overall, 94 (8.5%) patients had a LSM >8 kPa, including nine patients with a LSM
>13 kPa. The researchers note that although LSM values were normal in 4% of patients with perturbed liver tests, these tests came back as normal in 43% of patients with LSM >8 kPa.NAFLD and alcoholic liver disease (ALD) were diagnosed as the likely causes of chronic liver disease in 52 and 20 patients, respectively. Hepatitis B and C were diagnosed in nine patients, and primary biliary cirrhosis in one patient.

Liver biopsy results confirmed that all of the nine patients with LSM >13 kPa
had liver cirrhosis due to ALD or chronic hepatitis B/C. The remaining 18
biopsies showed liver fibrosis in all patients except one who presented with
isolated steatosis.

Factors significantly associated with a LSM >8 kPa included being aged 57 years
or older, having a body mass index ≥30 kg/m2, elevated waist circumference,
diabetes, alanine aminotransferase ≥40 UI/l, and γ-glutamyltranspeptidase
≥45 UI/l.

The researchers say the findings suggest that "a relatively high percentage of
liver diseases remain undiagnosed in apparently healthy individuals, and that
LSM might contribute to referring these patients to hepatologists."

They conclude in the journal Gut: "If future studies determine that the superior
positive predictive value of LSM can be achieved at an acceptable cost, compared
with common screening methods, LSM might represent a first-line procedure for
the mass screening of liver disease in the general population."


MedWire (www.medwire-news.md) is an independent clinical news service provided
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Springer Healthcare Ltd; 2010.                          

发布日期:24 - 12月2010

MedWire新闻：研究的结果表明，肝脏硬度测量器（LSM）可以
在看起来健康的人检测确诊慢性肝病，与
一个100％，阳性预测值筛选肝硬化额外的好处。

“到目前为止，肝活检已为肝纤维化的金标准评估
在慢性肝病患者，“说多米尼克Roulot（Avicenne
医院，博比尼，法国）和共同作者。

“然而，在非酒精性脂肪肝病（NAFLD）的怀疑的情况下，
肝活检是难以为患者建议显然与健康
正常肝测试，因为它可能出现的并发症，“他们补充。

从一般的人口总数1190人，45岁以上，
参加了一次体检，在目前的研究参加了会议。所有患者
收到LSM的，除了实验室测试和体检。这些
谁超过800千帕的LSM上得分均提到了肝脏单位进一步
调查。

总体而言，94（8.5％）患者进行了LSM的> 8 kPa时，包括9间LSM的患者
> 13千帕。研究人员注意到，虽然LSM的值在4％的正常与患者扰动肝测试，这些测试带回来LSM的> 8 kPa.NAFLD和酒精性肝病（ALD）作为可能的原因诊断为正常的43％的患者在52和20例，分别为慢性肝病。乙型和丙型肝炎诊断9例，与原发性胆汁性肝硬化患者之一。

肝活检结果证实，所有与LSM的> 13千帕的九例
由于有肝硬化或慢性乙型肝炎限期/角其余的18个
活检显示，所有患者除一人外谁提出与肝纤维化
孤立的脂肪变性。

一个显着的相关因素与LSM的> 8包括被57岁年龄千帕
或以上，身体质量指数有≥30 kg/m2，高架腰围，
糖尿病，谷丙转氨酶≥40的UI /升，和γ-谷氨酰转
≥45的UI /升

研究人员说，这些发现表明，“一个相对高比例
确诊肝脏疾病仍然在看起来健康的人，而
LSM的可能是造成这些病人转介到肝病。“

他们得出结论：在杂志肠：“如果未来的研究确定的优良
LSM的阳性预测值，可实现在一个可接受的成本相比，
共同筛选方法，可能代表了LSM的第一线程序
在总人口中的肝病普查。“


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