Fibro Scan in diagnosis of liver fibrosis in patients with different chronic liver diseases: a comparative analysis
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摘要: 目的比较Fibro Scan诊断不同类型慢性肝病肝纤维化的异同性。方法收集2012年10月-2015年1月就诊于北京大学第一医院的516例慢性肝病患者的临床资料,按照病因分为慢性乙型肝炎(CHB)组(n=305)、慢性丙型肝炎(CHC)组(n=117)及原发性胆汁性肝硬化(PBC)组(n=94),记录所有患者血常规、肝功能、肝脏弹性(FS)值以及腹部B超检查结果。按照FS值<7.3 k Pa、7.3 k Pa≤FS值<15 k Pa、FS值≥15 k Pa将每组患者分为不同的FS等级。计量资料和计数资料多组间比较采用KruskalWallis H检验,两组间比较采用Mann-Whitney U检验;FS值与年龄、性别、BMI、血常规、肝功能、超声各指标的相关性采用多重线性回归方法进行分析。结果 CHB组患者FS值的独立影响因素为性别、血红蛋白、AST、白蛋白、ALP、TBil、BMI、门静脉内径、腹水(P值均<0.05);CHC组患者FS值的独立影响因素为血小板、ALT、ALP、GGT、总胆汁酸、肝表面光滑度、脾静脉内径、腹水(P值均<0.05);PBC组患者F...Abstract: Objective To investigate the similarities and differences of Fibro Scan in the diagnosis of liver fibrosis in patients with different chronic liver diseases. Methods The clinical data of 516 patients with chronic liver diseases who visited Peking University First Hospital from October 2012 to January 2015 were collected,and according to the cause of disease,these patients were divided into chronic hepatitis B( CHB) group( 305 patients),chronic hepatitis C( CHC) group( 117 patients),and primary biliary cirrhosis( PBC) group( 94 patients). The routine blood test results,liver function,Fibro Scan( FS) value,and abdominal ultrasound findings were recorded. The patients in each group were further divided into subgroups with FS value < 7. 3 k Pa,7. 3 k Pa ≤FS value < 15 k Pa,or FS value ≥15 k Pa.The Kruskal- Wallis H test was used for comparison of continuous data and categorical data between multiple groups,and the Mann- Whitney U test was used for comparison between any two groups. The multiple linear regression was used to analyze the correlation of FS value with age,sex,body mass index( BMI),routine blood test results,liver function,and ultrasound parameters. Results In the CHB group,sex,hemoglobin,aspartate aminotransferase( AST),albumin,alkaline phosphatase( ALP),total bilirubin( TBil),BMI,diameter of the portal vein,and ascites were the independent influencing factors for FS value( all P < 0. 05); in the CHC group,platelet count,alanine aminotransferase( ALT),ALP,gamma- glutamyl transpeptidase( GGT),total bile acid,smoothness of liver surface,diameter of the portal vein,and ascites were the independent influencing factors for FS value( all P < 0. 05); in the PBC group,TBil,total bile acid,and ascites were the independent influencing factors for FS value( all P < 0. 05). Most indicators showed significant differences between CHB and CHC patients with different FS values( all P < 0. 05). In the PBC group,only ALT( Z =- 2. 121,P = 0. 034),AST( Z =- 3. 027,P =0. 002),and spleen length( Z =- 2. 496,P = 0. 013) showed significant differences between the FS value < 7. 3 k Pa subgroup and the7. 3 k Pa ≤FS value < 15 k Pa subgroup; platelet count( Z =- 2. 289,P = 0. 022),albumin( Z =- 2. 185,P = 0. 029),TBil( Z =- 2. 642,P = 0. 008),spleen thickness( Z =- 3. 317,P = 0. 001),spleen length( Z =- 2. 010,P = 0. 044),and diameter of the splenic vein( Z =- 2. 296,P = 0. 022) showed significant differences between the 7. 3 k Pa ≤FS value < 15 k Pa subgroup and the FS value ≥15 k Pa subgroup. Conclusion Different factors affect the FS value in patients with different causes. Total bile acid and TBil are important influencing factors for FS value in PBC patients,while liver function greatly influences FS value in CHB and CHC patients,suggesting that the threshold values for Fibro Scan in the diagnosis of liver fibrosis should be set independently for different causes of disease.
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Key words:
- liver cirrhosis /
- hepatitis B /
- chronic /
- hepatitis C /
- chronic /
- liver cirrhosis
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[1]KLIEMANN DA,WOLFF FH,TOVO CV,et al.Biochemical non-invasive assessment of liver fibrosis cannot replace biopsy in HIV-HCV coinfected patients[J].Ann Hepatol,2016,15(1):27-32. [2]ZHU CL,WANG K,GAO RT.Clinical application of noninvasive diagnosis of liver fibrosis[J].J Clin Hepatol,2015,31(3):332-336.(in Chinese)朱传龙,王坤,高人焘.肝纤维化无创性诊断技术的临床应用[J].临床肝胆病杂志,2015,31(3):332-336. [3]KIM SU,JANG HW,CHEONG JY,et al.The usefulness of liver stiffness measurement using Fibro Scan in chronic hepatitis C in South Korea:a multicenter,prospective study[J].J Gastroenterol Hepatol,2011,26(1):171-178. [4]MARCELLIN P,ZIOL M,BEDOSSA P,et al.Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B[J].Liver Int,2009,29(2):242-247. [5] CHON YE,CHOI EH,SONG KJ,et al.Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B:a meta-analysis[J].PLo S One,2012,7(9):e44930. [6]FRIEDRICH-RUST M,MLLER C,WINCKLER A,et al.Assessment of liver fibrosis and steatosis in PBC with Fibro Scan,MRI,MRspectroscopy,and serum markers[J].J Clin Gastroenterol,2010,44(1):58-65. [7]FERNANDEZ M,TRPO E,DEGRD,et al.Transient elastography using Fibroscan is the most reliable noninvasive method for the diagnosis of advanced fibrosis and cirrhosis in alcoholic liver disease[J].Eur J Gastroenterol Hepatol,2015,27(9):1074-1079. [8]FRIEDRICH-RUST M,ONG MF,MARTENS S,et al.Performance of transient elastography for the staging of liver fibrosis:a meta-analysis[J].Gastroenterology,2008,134(4):960-974. [9] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J].Chin J Epidemiol,2011,32(4):405-415.中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].中华流行病学杂志,2011,32(4):405-415. [10]European Association for the Study of the Liver.EASL clinical practice guidelines:management of hepatitis C virus infection[J].J Hepatol,2011,55(2):245-264. [11]Chinese Rheumatology Association.Guidelines for the diagnosis and treatment of autoimmune liver diseases[J].Chin J Rheumatol,2011,15(8):556-558.(in Chinese)中华医学会风湿病学分会.自身免疫性肝病诊断和治疗指南[J].中华风湿病学杂志,2011,15(8):556-558. [12]SEO YS,KIM MY,KIM SU,et al.Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis:A multicentre,retrospective study[J].Liver Int,2015,35(10):2246-2255. [13]LIU LF,LU HY,YU YY,et al.A comparative study of Fibro Scan and B ultrasound in diagnosis of liver fibrosis[J].J Clin Hepatol,2014,30(10):1045-1049.(in Chinese)刘玲峰,陆海英,于岩岩,等.Fibro Scan检测与超声检查对肝纤维化程度诊断价值的对比分析[J].临床肝胆病杂志,2014,30(10):1045-1049. [14]MILLONIG G,REIMANN FM,FRIEDRICH S,et al.Extrahepatic cholestasis increases liver stiffness(Fibro Scan)irrespective of fibrosis[J].Hepatology,2008,48(5):1718-1723. [15]van GOSSUM A,PIRONI L,MESSING B,et al.Transient elastography(Fibro Scan)is not correlated with liver fibrosis but with cholestasis in patients with long-term home parenteral nutrition[J].JPEN J Parenter Enteral Nutr,2015,39(6):719-724.
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